الفهرس 
Introduction &Aim of the workOnly 14 pages are availabe for public view
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Abstract
Thirty patients were included in the study,13 females (43.3%) and 17 males ( 56.6% ), mean of the age was 49 years. (range24-65year), most of them had adenocarcinoma of the rectum.
The main presenting symptom was bleeding per rectum(56.7%). The dose of radiotherapy 5040 cGy /25ttt,and Gemcitabine dose is 45mg/m2 given twice weekly during radiotherapy sessions only.
As regard to the response to the neoadjuvant treatmen 12/30 patients (40%) achieved Partial response, 8/30patients(27.6%) achieved complete response and 10/30 patients (33%) had no response .
.Abdomino - perineal resection was performed in 19 patients(63.3%) and 11 patients (36.7%) underwent sphincter preservation operation.
About the toxicity in this study,for Gemcitabyne; diarrhea was the most common manifestation which seen in 25 patients(83%),followed by loss of appetite seen in 9 patients(63.3%), for radiotherapy 19 patients (63%) developed wet desquamation.
The rate of Overall Survival of our 2-years study is (80%),the Disease free survival is (63%)while the progression free survival is (72%).
N stage was the only significant factor affecting the disease free survival and overall survival.
All patients tolerate the treatment protocol and not associated with no life threatening events .
CONCLUSIONS
-Pre-operative chemo-radiotherapy with type 0f dose and fractionation schedule used in the present study is safe, effective and well tolerated.
-Pre-operative chemo-radiotherapy allowed sphincter preservation in the form of Trans-anal abdominally assisted colon-anal pull-through was performed in (36.7%) of patients and (63.3%) of patients underwent Abdomino-Perineal resection.
-Pre-operative chemo-radiotherapy allowed curative surgery as survival and regards tumor response to neo-adjuvant therapy; which was 26.7% achieved complete response,40% achieved partial response and 33% are stationary.
-In the present study ,the only significant prognostic factor affecting disease free survival and overall survival was N staging.
-The rate of overall survival in the present study is 80%, disease free survival is 63% and progression free survival is 72%.
Recommendations
Pre-operative chemo-radiotherapy should be considered in the management of patients having locally advanced rectal cancer with borderline respectability and patients not suitable for sphincter preservation.
This study is based on a relatively small number of patients, therefore large number of patients should be included in a larger study to confirm the results.