Surgery is the main treatment modality in rectal cancer. Therefore, in this study, the aim is not to present data on the efficacy of surgical treatment. We investigated the effectiveness of treatment methods other than surgical treatment. Consequently we consider that only CRT or CT following CRT may be administered in patients with locally advanced rectal cancer who cannot undergo surgical treatment due to advanced age, poor

performance status, significant comorbid diseases, surgery refusals or Inhibitors,research,lifescience,medical not operable due to any other reason. Acknowledgements Tanespimycin manufacturer Disclosure: The authors declare no conflict of interest.
In the last 20 years there have been many advances Inhibitors,research,lifescience,medical in the treatment of colorectal cancer. Response rates of 12% with 5-flourouacil (5-FU) and leucovorin (LV) have increased to at least 50% with a combinations of 5-FU/LV with Oxaliplatin or Irinotecan (CPT), +/- Bevacizumab, Panitumumab or Cetuximab. However, the median survival, though an improvement from 14 months up to 26 months, has not changed in the last few years (1), even with the addition of two new drugs, aflibercept and regorafenib. Inhibitors,research,lifescience,medical The study by Nanashima et al. (2) reported in this month’s

journal used old drugs, FU or CPT via the hepatic artery on 36 patients with colorectal liver metastases, 16 of whom had progressed after liver resection. Four of the patients had a complete response, 19 a partial response, for a total response rate of 64%. The median survival was 32 months, with the complete

responders having a median survival of 62 months. Although, this is a small study and therefore difficult to make firm interpretations, the authors did have an interesting point, which is that by using old relatively Inhibitors,research,lifescience,medical inexpensive drugs, they were able to get a similar response and survival as seen in studies using new agents, which are quite expensive. Nanashima (2) stated that the cost of treating patients in Euros with arterial injections with 5FU or CPT was 3,590 Euros, while it was 75,534 Euros when Folfox treatment was used. This Bay 11-7085 of course Inhibitors,research,lifescience,medical doesn’t consider the extra cost that would be required if targeted agents were used. In an English study (3) when the cost of hepatic arterial infusion (HAI) therapy using a pump inserted at laparotomy was compared to systemic 5-FU/LV, the cost was more, but HAI therapy was more cost effective than systemic, when health care plus societal cost per life-year gained were considered. In an American randomized study (4) of HAI vs. Systemic, four quality of life end points were assessed. The study demonstrated that at 3 and 6 months the physical functioning was significantly improved for the HAI patients. The goal of regional therapy is to increase therapeutic efficacy by increasing local concentration of the drugs and decreasing systemic exposure.