PURPOSE:In radiotherapy for bleeding gastric cancer, no standard response definition exists; studies have used transfusion-only or transfusion-plus-hemoglobin criteria. After inter-facility transfer or during home care-sometimes following palliative radiotherapy-laboratory results from other facilities are often unavailable, leaving patients inevaluable. We therefore tested whether omitting hemoglobin compromises the precision of response assessment. METHODS AND MATERIALS:In criteria A, referring to our original study, patients were diagnosed as responders when all the following three conditions were met: (1) hemoglobin levels ≥ 8.0 g/dL; (2) 14 consecutive days without blood transfusion before blood sampling; and (3) no salvage treatment. In criteria B, patients were diagnosed as responders when only (2) and (3) of the above conditions were met. The strength of agreement between criteria A and B was estimated by calculating Gwet's first-order agreement coefficient (AC1) at 4- and 8-week follow-up for patients completing planned radiotherapy with assessable response. RESULTS:In 36 evaluable patients at 4-week follow-up, response rates were 69% (25/36) by criteria A vs. 78% (28/36) by criteria B (AC1, 0.86; almost perfect agreement). In 30 evaluable patients at 8-week follow-up, response rates were 83% (25/30) by criteria A vs. 90% (27/30) by criteria B (AC1, 0.91; almost perfect agreement). CONCLUSIONS:Criteria A and B showed almost perfect agreement at 4- and 8-week assessments among evaluable patients with available hemoglobin data. ADVANCES IN KNOWLEDGE:Among patients with available hemoglobin data, criteria A and B showed almost perfect agreement. The observed agreement may not be fully generalizable to patients without hemoglobin assessment.

BACKGROUND/AIM:T4 esophageal cancer that has invaded adjacent organs is often symptomatic and unresectable, and radiotherapy represents an important treatment option. Treatment strategies range from definitive to palliative approaches, making accurate prognostic assessment essential in clinical practice. Immunonutritional indices, such as the Glasgow Prognostic Score (GPS) and the Prognostic Nutritional Index (PNI), can be easily calculated from routine blood tests and have been reported as prognostic factors in various malignancies. However, their clinical significance in patients with T4 esophageal cancer treated with radiotherapy remains unclear. PATIENTS AND METHODS:We retrospectively analyzed 79 patients with T4 esophageal cancer who were treated with radiotherapy. GPS was calculated based on serum C-reactive protein and albumin levels, and PNI was calculated using serum albumin levels and total lymphocyte counts. Overall survival (OS) was compared according to pretreatment GPS and PNI. RESULTS:Pretreatment GPS scores were zero in 26 patients, one in 23 patients, and two in 30 patients, and the median pretreatment PNI was 40.7. The median OS for all 79 patients was 12 months. When patients were dichotomized into GPS 0/1 (N=49) and GPS 2 (N=30) groups, OS was significantly longer in the GPS 0/1 group than in the GPS 2 group (p=0.00224). Patients were also stratified according to a PNI cut-off value of 41 into a high-PNI group (PNI ≥41, N=38) and a low-PNI group (PNI <41, N=41); OS was significantly longer in the high-PNI group than in the low-PNI group (p=0.021). CONCLUSION:GPS and PNI, which are readily available from routine blood tests, are simple and useful prognostic indicators in patients with T4 esophageal cancer undergoing radiotherapy.

To date, no review has specifically focused on palliative-intent radiotherapy (RT) for pancreatic cancer (PC)–related pain. This study aimed to evaluate the pain response after palliative-intent RT for PC–related pain. A comprehensive literature search was conducted using PubMed, Ichushi-Web, and the Cochrane Library for studies published between 1971 and 2024. Studies in which palliative-intent RT was administered for PC-related pain were included. Extracted Data were independently assessed by three reviewers. Of the 629 studies identified through the database search, 11 met the inclusion criteria. The most frequently used palliative-intent RT schedules were 30 Gy in 10 fractions for conventional RT and 25 Gy in a single fraction for stereotactic body radiotherapy (SBRT). In addition, 8 Gy once weekly (24 Gy in 3 fractions) RT has also been reported. Because the methods used for pain assessment varied across the included studies, a meta-analysis was considered inappropriate. Pain associated with PC improved following palliative-intent conventional RT (pain response rate, 69–94

Objective: Single-center studies or randomized controlled trials have evaluated the impact of radiotherapy for bone metastases on quality of life (QOL). We investigated the real-world impact of radiotherapy for bone metastases on QOL using nationwide multicenter cohort data. Methods: We conducted a prospective observational study at 26 centers in Japan. Of 333 patients who received radiotherapy for bone metastases between December 2020 and March 2021, 232 (70%) were enrolled in the study. Patient-reported QOL was evaluated at enrollment and at two- and six-month follow-up using the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 15-Palliative and the EORTC QOL Questionnaire Bone Metastases module (QLQ-BM22). Possible predictors (patient-, tumor-, and treatment-related factors) of QOL improvement were screened using logistic regression models. Results: QOL scores showed significant improvement at two-month follow-up in seven (global health status/QOL, emotional functioning, pain, insomnia, painful sites, pain characteristics and functional interference) of the 14 scales. Of these seven scales, mean improvement >= the minimal clinically important difference (defined by a change of 10 or more on the 0 to 100 scale) was seen in four scales (pain, insomnia, pain characteristics and functional interference). We did not find any predictors of QOL improvement in the functional interference scale of QLQ-BM22. Conclusion: Radiotherapy for bone metastases performed in daily practice is effective in improving some scales of QOL.

Background and purpose Volumetric modulated arc therapy (VMAT) with a C-arm linear accelerator has been adopted for stereotactic radiosurgery (SRS) for treating brain tumors. Some treatment planning systems (TPSs) generate sequences that align the jaw with the edge of the multileaf collimator (MLC) radiation field during VMAT. However, the jaw exhibits greater geometric positioning uncertainty than the MLC. In this study, we investigated the effect of jaw positioning uncertainty on dose distribution in VMAT-SRS and evaluated the effectiveness of our proposed method. Methods The RayStation software (RaySearch Laboratories, Stockholm, Sweden) was used for the TPS and a TrueBeam STx linear accelerator (Varian Medical Systems, Palo Alto, USA) for the C-arm linear accelerator. A target simulating a brain tumor was placed in the phantom, for which three treatment plans implementing VMAT-SRS were created: one using the jaw tracking technique (JT plan), another with a fixed jaw (FJ plan), and a third with the jaw fixed 1 mm outward from the edge of the MLC (FJ1mm plan). The change in the dose-volume parameters relative to the original plan was evaluated when the jaw position at each control point in each plan was systematically changed by ±1 mm. Results The maximum changes in the absolute dose received by 99% of the gross tumor volume from the original plans were -7.0%, -5.6%, and -1.1% in the JT, FJ, and FJ1mm plans, respectively. The maximum changes in the absolute dose received by 99% of the planning target volume were -13.1%, -12.0%, and -2.2%, respectively. The ranges of change in the absolute volume of the normal brain receiving a dose greater than 12 Gy for the original plans were -1.3 to 0.6 cm3, -0.7 to 0.4 cm3, and -0.4 to 0.1 cm3, respectively. Conclusion Even when the quality control levels recommended by the jaw positioning guidelines were met, target dose variations of >10% were observed depending on the existing VMAT-SRS. Our proposed method was the most robust, with a target dose variation of <3%.

Intramedullary spinal cord metastasis (ISCM) is a rare condition. ISCM from esophageal cancer is extremely uncommon. We report a rare case of lumbar ISCM from esophageal cancer in a woman in her 70 s, initially diagnosed with clinical stage IVA (cT4bN1M0) esophageal cancer. She underwent definitive radiotherapy (60 Gy in 30 fractions) with concurrent chemotherapy of 5-fluorouracil and cisplatin (FP), followed by two additional cycles of FP chemotherapy. A complete response was maintained for 1 year and 7 months post-radiotherapy by endoscopy. However, the patient began to experience mild bladder and rectal dysfunction and back pain. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed high FDG uptake in the spinal cord cavity at the L1 level and contrast-enhanced spinal magnetic resonance imaging (MRI) showed an intramedullary tumor corresponding to the areas of FDG accumulation. Based on the appearance of new lesions and elevated tumor markers, the lesion was diagnosed as ISCM from esophageal cancer rather than a primary spinal cord tumor, and palliative radiotherapy (20 Gy in 5 fractions) was promptly administered. Two months after radiotherapy, the patient’s neurologic symptoms improved, and she continued treatment with immune chemotherapy. To our knowledge, this is the first reported case of immune checkpoint inhibitors after the diagnosis of ISCM from esophageal cancer. Although rare, ISCM should be considered in cancer patients presenting with new neurological symptoms, and timely multidisciplinary intervention is essential for optimal management.

Purpose Although pain response is assessed based on the intensity of index pain (pain from the tumor targeted for radiation therapy), few studies have explored nonindex pain (pain from other sites not targeted for radiation therapy). We examined the impact of pretreatment nonindex pain on quality of life (QOL) after radiation therapy. Methods and Materials Of 232 patients enrolled in the original prospective observational study conducted at 26 centers, 223 were analyzed. All enrolled patients received radiation therapy for pain due to bone metastases. QOL was measured using the EuroQol 5-dimensions 5-levels, the European Organization for Research and Treatment of Cancer QOL Questionnaire Core 15-Palliative, and the European Organization for Research and Treatment of Cancer QOL Questionnaire Bone Metastases module. Pain response was assessed based on the International Consensus Pain Response Endpoints. Results Nonindex pain was present in 44%, 33%, and 39% of evaluable patients at baseline, 2 months, and 6 months, respectively. Nonindex pain at baseline was associated with persistent nonindex pain at 2 months (odds ratio, 4.92; 95% confidence interval, 2.42-10.32; P < .001). Patients who had nonindex pain at baseline were significantly less likely to report a pain response at 2 months than those without it (odds ratio, 0.47; 95% confidence interval, 0.24-0.91; P = .021). The presence of nonindex pain at baseline was significantly associated with worse QOL in terms of utility (P = .003) and the global health status/QOL (P = .005) and physical functioning (P = .008) scales of the European Organization for Research and Treatment of Cancer QOL Questionnaire Core 15-Palliative at 2 months. The presence of nonindex pain at baseline was significantly associated with worse overall survival (P = .008). Conclusions The presence of nonindex pain at baseline was significantly associated with a lower likelihood of pain response, worse QOL, and shorter survival following radiation therapy. Evaluation of both nonindex and index pain is desirable in future studies on palliative radiation therapy for bone metastases.

Purpose of this study is to evaluate patient characteristics, treatments and outcomes in bone metastasis radiotherapy practice. Patients for whom radiotherapy for bone metastasis was planned at 26 institutions in Japan between December 2020 and March 2021 were consecutively registered in this prospective, observational study. Study measures included patient characteristics, pain relief, skeletal-related events (SREs), overall survival and incidence of radiation-related adverse events. Pain was evaluated using a numerical rating scale (NRS) from 0 to 10. Irradiated dose was analyzed by the biologically effective dose (BED) assuming alpha/beta = 10. Overall, 232 patients were registered; 224 patients and 302 lesions were fully analyzed. Eastern Cooperative Oncology Group Performance Status was 0/1/2/3/4 in 23%/38%/22%/13%/4%; 59% of patients had spinal metastases and 84% had painful lesions (NRS >= 2). BED was <20 Gy (in 27%), 20-30 Gy (24%), 30-40 Gy (36%) and >= 40 Gy (13%); 9% of patients were treated by stereotactic body radiotherapy. Grade 3 adverse events occurred in 4% and no grade 4-5 toxicity was reported. Pain relief was achieved in 52% at 2 months. BED is not related to pain relief. The cumulative incidence of SREs was 6.5% (95% confidence interval (CI) 3.1-9.9) at 6 months; no factors were significantly associated with SREs. With spinal lesions, 18% of patients were not ambulatory at baseline and 50% of evaluable patients in this group could walk at 2 months. The 6-month overall survival rate was 70.2% (95% CI 64.2-76.9%). In conclusion, we report real-world details of radiotherapy in bone metastasis.

We sought to identify potential evidence-practice gaps in palliative radiotherapy using quality indicators (QIs), previously developed using a modified Delphi method. Seven QIs were used to assess the quality of radiotherapy for bone metastases (BoM) and brain metastases (BrM). Compliance rate was calculated as the percentage of patients for whom recommended medical care was conducted. Random effects models were used to estimate the pooled compliance rates. Of the 39 invited radiation oncologists, 29 (74%) from 29 centers participated in the survey; 13 (45%) were academic and 16 (55%) were non-academic hospitals. For the QIs, except for BoM-4, the pooled compliance rates were higher than 80%; however, for at least some of the centers, the compliance rate was lower than these pooled rates. For BoM-4 regarding steroid use concurrent with radiotherapy for malignant spinal cord compression, the pooled compliance rate was as low as 32%. For BoM-1 regarding the choice of radiation schedule, the compliance rate was higher in academic hospitals than in non-academic hospitals (P = 0.021). For BrM-3 regarding the initiation of radiotherapy without delay, the compliance rate was lower in academic hospitals than in non-academic hospitals (P = 0.016). In conclusion, overall, compliance rates were high; however, for many QIs, practice remains to be improved in at least some centers. Steroids are infrequently used concurrently with radiotherapy for malignant spinal cord compression.

Background: Utility values of responders and nonresponders are essential inputs in cost-effectiveness studies of radiation therapy for painful bone metastases but, to our knowledge, they have not been reported separately.Objective: We sought to determine the utility values of responders and nonresponders using data from a prospective observational study on bone metastases.Methods: The original prospective observational study was conducted at 26 centers in Japan. Of 232 enrolled patients, 181 whose pain scores at baseline were >= 2 were analyzed. Health-related quality of life (QOL) was measured using the EuroQol 5-dimensions 5-levels (EQ-5D-5L) instrument at baseline and 2- and 6-month follow-up assessments. At follow-up assessments, patients were categorized as responders or nonresponders. Pain response was assessed using the International Consensus Pain Response Endpoints.Results: Of the 181 patients analyzed, 133 (73%) and 84 (46%) were evaluable at the 2- and 6-month follow-up assessment, respectively. The EQ-5D-5L index score (utility) increased from baseline to the 2- and 6-month follow-up assessments; regarding opioid analgesic use, no clear trend was observed during the same period. The mean utility was significantly higher in responders than in nonresponders at both follow-up times. The mean daily oral morphine equivalent dose was significantly lower in responders than in nonresponders at both follow-up times.Conclusion: We determined utility values for responders and nonresponders. Pain response was associated with better QOL and less opioid use. Our utility values according to response status can be used for model input in future cost-effectiveness studies on radiation therapy for bone metastases.

OBJECTIVE:To identify factors significantly associated with quality of life (QOL) and determine if these associations are strong enough to predict certain aspects of QOL without measuring them. METHODS:We conducted an exploratory secondary analysis of baseline data of 224 patients (enrolled between December 2020 and March 2021) from a previously published prospective observational study on radiotherapy for bone metastases at 26 centres. Using univariable linear regression, we assessed the association between patient/treatment factors and QOL scale scores as measured by the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 15-Palliative (QLQ-C15-PAL) and the EORTC QOL Questionnaire Bone Metastases module (QLQ-BM22). RESULTS:Age and sex were not significantly associated with QOL. Worse performance status, higher pain scores, and opioid and single-fraction use were significantly associated with most QOL scales; these four factors were associated with worse global QOL, worse functioning status, and more severe symptoms. The coefficients of determination for most QOL scales were less than 0.2, indicating that most of the variability in QOL scores was not explained by any of the explanatory variables. CONCLUSION:Performance status, pain intensity, and opioid and single-fraction use were significantly associated with most QOL scales. However, the associations were not strong enough to estimate QOL. ADVANCES IN KNOWLEDGE:To date, the association between treatment factors and QOL in patients with bone metastases has not been fully studied. We identified the factors that were significantly associated with QOL and found that these associations were not strong enough to predict QOL.

Purpose:Although the Palliative Prognostic Index (PPI) has been used to predict survival in various cancers, to our knowledge, no study has examined its applicability in gastric cancer. This study aimed to determine the baseline PPI cutoff value for recommending single-fraction radiotherapy in patients with bleeding gastric cancer. Materials and methods:This was a secondary analysis of the Japanese Radiation Oncology Study Group (JROSG) 17-3, a multicenter prospective study of palliative radiotherapy for bleeding gastric cancer. Discrimination was evaluated using a time-dependent receiver operating characteristic curve, and the optimal cutoff value was determined using the Youden index. A calibration plot was used to assess the agreement between predicted and observed survival. Results:We enrolled 55 patients in JROSG 17-3. The respective median survival times were 6.7, 2.8, and 1.0 months (p = 0.021) for patients with baseline PPI scores of ≤ 2, 2 < PPI ≤ 4, and PPI > 4. The areas under the curve for predicting death within 2, 3, 4, and 5 months were 0.813, 0.787, 0.775, and 0.721, respectively. The negative predictive value was highest when survival < 2 months was predicted and the Youden index was highest when the cutoff PPI value was 2. The calibration curve showed a reasonable agreement between the predicted and observed survival. Conclusion:Baseline PPI is useful for estimating short-term prognosis in patients treated with palliative radiotherapy for gastric cancer bleeding. A cutoff PPI value of 2 for estimating survival ≤ 2 months should be used to recommend single-fraction radiotherapy.

Purpose: The aim of this study was to understand the income and employment status of patients at the start of and during follow-up after palliative radiation therapy for bone metastasis. Methods and Materials: From December 2020 to March 2021, a prospective multi-institutional observational study was conducted to investigate income and employment of patients at the start of administration of radiation therapy for bone metastasis and at 2 and 6 months after treatment. Of 333 patients referred to radiation therapy for bone metastasis, 101 were not registered, mainly because of their poor general condition, and another 8 were excluded from the follow-up analysis owing to ineligibility. Results: In 224 patients analyzed, 108 had retired for reasons unrelated to cancer, 43 had retired for reasons related to cancer, 31 were taking leave, and 2 had lost their jobs at the time of registration. The number of patients who were in the working group was 40 (30 with no change in income and 10 with decreased income) at registration, 35 at 2 months, and 24 at 6 months. Younger patients (P = 0), patients with better performance status (P = 0), patients who were ambulatory (P = .008), and patients with lower scores on a numerical rating scale of pain (P = 0) were significantly more likely to be in the working group at registration. There were 9 patients who experienced improvements in their working status or income at least once in the follow-up after radiation therapy. Conclusions: The majority of patients with bone metastasis were not working at the start of or after radiation therapy, but the number of patients who were working was not negligible. Radiation oncologists should be aware of the working status of patients and provide appropriate support for each patient. The benefit of radiation therapy to support patients continuing their work and returning to work should be investigated further in prospective studies. & COPY; 2023 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

本邦の高線量率密封小線源治療は施設当たりの症例数が少ないため，診療用放射線照射装置使用室（RALS室）に専用のCT装置（RALS室CT）の導入が困難なことが，IGBT普及の足枷となっている。しかしながら，RALS室に設置した放射線機器の使用は，医療法で許認可された治療目的である，高線量率密封小線源治療に必要な画像取得の用途に限定されている。そこで，RALS室CTの有効活用を目的に，アンケート調査を行った。RALS室CTは使用時間や日数が少ないため，外部照射の治療計画に用いるCT撮影などへの活用の要望が多かった。IGBTのいっそうの普及には，RALS室CTを許認可された治療目的以外に単独使用できることが一助となる。

BACKGROUND/AIMIn advanced stage lung cancer, bulky tumors can cause serious symptoms such as malignant airway obstruction (MAO). Prompt response to airway obstruction might be essential to improve quality of life and prolong life expectancy. Palliative external beam radiotherapy (EBRT) is a less invasive and highly safe treatment method that can alleviate symptoms and at the same time treat lung cancer. However, there are few reports on the results of palliative radiotherapy performed for improving airway obstruction and obstructive pneumonia. Therefore, this study retrospectively examined the effectiveness of palliative radiotherapy.PATIENTS AND METHODSWe reviewed 38 lung cancer patients with MAO who underwent EBRT. Patients were treated with a median dose of 37.5 Gy (range=30-40 Gy) in 10-20 fractions. Whether a patient was a responder or non-responder was assessed by whether the bronchus that was obstructed before EBRT reopened or improvement of obstructive pneumonia was observed on follow-up chest X-ray or computed tomography after EBRT.RESULTSThe median survival time was 135 days (range=31-469 days) for the responders to EBRT and 45 days (range=23-355 days) for non-responders; this difference was statistically significant (p=0.03). One-year overall survival rate was 18.5% and 0% for the responders to EBRT and non-responders, respectively.CONCLUSIONPalliative EBRT might be an important option for non-curative lung cancer patients with MAO.

Purpose The purpose of this study is to evaluate the prediction and classification performances of the gamma passing rate (GPR) for different machine learning models and to select the best model for achieving machine learning-based patient-specific quality assurance (PSQA). Methods The measurement verification of 356 head-and-neck volumetric modulated arc therapy plans was performed using a diode array phantom (Delta4 Phantom), and GPR values at 2%/2 mm with global normalization and 3%/2 mm with local normalization were calculated. Machine learning models, including ridge regression (RIDGE), random forest (RF), support vector regression (SVR), and stacked generalization (STACKING), were used to predict the GPR. Each machine learning model was trained using 260 plans, and the prediction accuracy was evaluated using the remaining 96 plans. The prediction error between the measured and predicted GPR was evaluated. For the classification evaluation, the lower control limit for the measured GPR and lower control limit for predicted GPR (LCLp) was defined to identify whether the GPR values represent a "pass" or a "fail." LCLp values with 99% and 99.9% confidence levels were calculated as the upper prediction limits for the GPR estimated from the linear regression between the measured and predicted GPR. Results There was an overestimation trend of the low measured GPR. The maximum prediction errors for RIDGE, RF, SVR, and STACKING were 3.2%, 2.9%, 2.3%, and 2.2% at the global 2%/2 mm and 6.3%, 6.6%, 6.1%, and 5.5% at the local 3%/2 mm, respectively. In the global 2%/2 mm, the sensitivity was 100% for all the machine learning models except RIDGE when using 99% LCLp. The specificity was 76.1% for RIDGE, RF, and SVR and 66.3% for STACKING; however, the specificity decreased dramatically when 99.9% LCLp was used. In the local 3%/2 mm, however, only STACKING showed 100% sensitivity when using 99% LCLp. The decrease in the specificity using 99.9% LCLp was smaller than that in the global 2%/2 mm, and the specificity for RIDGE, RF, SVR, and STACKING was 61.3%, 61.3%, 72.0%, and 66.8%, respectively. Conclusions STACKING had better prediction accuracy for low GPR values than other machine learning models. Applying LCLp to a regression model enabled the consistent evaluation of quantitative and qualitative GPR predictions. Adjusting the confidence level of the LCLp helped improve the balance between the sensitivity and specificity. We suggest that STACKING can assist the safe and efficient operation of PSQA.

Li-Fraumeni syndrome(LFS)is a hereditary cancer disorder caused by germline variant in TP53 and characterized by various malignancies. Multidisciplinary treatment is needed for tumors of LFS, however, radiation therapy is a relative contraindication because of frequent development of secondary malignancy such as sarcoma in the irradiated field. Case 1: A 22- year-old woman who was diagnosed with LFS by genetic test when she developed upper rectal cancer. Her rectal tumor with marked bilateral lateral lymph node dissection was successfully removed by low anterior resection with extensive lateral lymph node dissection. She underwent resection for ovarian metastasis followed by chemotherapy and radiotherapy but subsequently died by the disease 32 months postoperatively. Case 2(elder sister of Case 1): A brain tumor was identified in the left high frontal lobe to the parietal lobe because of consciousness disorder, after the genetic diagnosis of LFS. The brain tumor was successfully resected. Histological examination revealed diffuse astrocytoma(WHO grade Ⅱ). Local recurrence was observed 46 months later, and radiation therapy was performed. Six months have passed since radiation therapy, no exacerbation of local recurrence has been observed.

Background Preoperative chemoradiotherapy(CRT)followed by total mesorectal excision(TME)is used for locally advanced rectal cancer, but it can induce postoperative anorectal function. The primary objective of this study is to confirm the efficacy and safety of preoperative CRT and TME without irradiation to the internal and external sphincter muscles. Subjects and methods Patients were eligible for this study if they met the following inclusion criteria: histologically proven rectal cancer, clinical T3T4N0-2 disease, and a distance between anal margin of tumor and the rental line is more than 2 cm. Twelve patients who underwent preoperative CRT and TME between 2013 and 2017 were enrolled. The primary endpoint was completion rate of sphincter-preserving surgery. Results All patients completed preoperative CRT without Grade 3 or higher adverse effect. Sphincter-preserving surgery was performed in all cases. The 5-year disease-free survival rate was 46.7%, and the local recurrence-free survival rate was 75%, and the overall survival rate was 90.9%. Conclusion It is suggested that preoperative CRT and TME without irradiation to the internal and external sphincter muscles is effective and safe therapy for locally advanced rectal cancer.