4039 Background: Adjuvant radiation (R) and chemotherapy (C) is generally recommended for patients (pts) with pT3N0 rectal cancer. Patterns of adjuvant therapy and outcomes among pts with pT3N0 rectal cancer referred to the British Columbia Cancer Agency (BCCA) were determined. Methods: The BCCA Colorectal Cancer Outcomes Unit database was used to identify referred pts with pT3N0 rectal carcinoma diagnosed between 2000–2004. During this period, “short course” R (25Gy/5, surgery within 10 days) was recommended for resectable cT3 tumors followed by 6 months of C. If not treated pre-operatively (pre-op), guidelines specified post-op “long course” (45Gy/25) R and C. Three treatment groups were identified: Surgery alone (S), S and R (SR), and S, R and C (SRC). Eligible pts had complete surgical resection with or without Total Mesorectal Excision (TME). Pts treated with “downstaging” pre-op long course R, with S and C only (13 pts) or with R2 resection were excluded. Locoregional Recurrence (LR) and Distant Recurrence (DR) rates determined. Reasons for non-treatment were determined by chart review. Results: 303 pts were identified, with median follow-up of 33.5 months. Significant differences in age, tumor height, grade, and R therapy existed between groups ( Table I ). TME status, R status and Radial Margin positivity were similar. LR rates were 15% (S), 2% (SR) and 1.4% (SRC). DR rates were 11.7% (S), 7.9% (SR) and 8.5% (SRC). Median Overall Survival (OS) and Disease Free Survival (DFS) was not reached. Conclusions: Treatment of pT3N0 rectal cancer was variable and significant heterogeneity existed between groups receiving S, SR and SRC. Nevertheless, LR rates were very low in pts receiving R and substantially higher in pts who did not. DR rates were similar across groups, irrespective of C history. Reasons for not receiving R or C were primarily patient related (medical/post- operative considerations, patient refusal). Potential physician related factors (non-referral) accounted for 28% of lack of C treatment in the SR group. [Table: see text] No significant financial relationships to disclose.

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597 Background: Adjuvant radiation (R) and chemotherapy (C) is generally recommended for patients (pts) with pT3N0 rectal cancer, although there is no data to support the use of adjuvant chemotherapy. This study examines the whether there is benefit with trimodality therapy vs. dual modality in this population. Methods: The BCCA Colorectal Cancer Outcomes Unit database was used to identify referred pts with pT3N0 rectal carcinoma diagnosed between 2000-2004. The data from this cohort has been previously reported (Johal et al. ASCO Annual Meeting 2007) During this period, “short course” R (25Gy/5, surgery within 10 days) was recommended for resectable cT3 tumors followed by 6 months of C. If not treated pre-operatively (pre-op), guidelines specified post-op “long course” (45Gy/25) R and C. Three treatment groups were identified: Surgery alone (S), S and R (SR), and S, R and C (SRC). Eligible pts had complete surgical resection with or without total mesorectal Excision (TME). Pts treated with “downstaging” pre-op long course R, with S and C only (13 pts) or with R2 resection were excluded. Locoregional Recurrence (LR) and Distant Recurrence (DR) rates determined. Reasons for non-treatment were determined by chart review. Due to the heterogeneity between the groups, a univariate and multivariate analysis was performed. Results: The patient characteristics have been previously reported. 5-yr LR was similar between SR and SRC (3.84 %vs. 6.34% p=0.474). 5-yr DR were 24.81% (SR), and 17.56% (SRC) p=0.0354 and 5 yr OS 68.4% (SR), and 86% (SRC) p=.0002. On multivariate analysis, chemotherapy did impact on OS with a HR of 0.532, p=0.0462. Conclusions: Treatment of pT3N0 rectal cancer was variable in clinical practice despite established guidelines. There was significant heterogeneity with respect to comorbid medical conditions between groups receiving SR and SRC which limits comparability between groups. However, those patients who received tri-modality therapy experienced less distant relapse and an increase in overall survival. No significant financial relationships to disclose.

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Bronchioloalveolar carcinoma is a fascinating and unusual variant of nonsmall-cell lung cancer that has a tendency towards an indolent course and to metastasize to the lung rather than distant organs. Chemotherapy has shown activity in advanced bronchioloalveolar carcinoma but response rates remain low. Epidermal growth factor receptor tyrosine kinase inhibitors have shown impressive activity against bronchioloalveolar carcinoma in trials. New data suggest that epidermal growth factor receptor mutations and gene copy number may predict subsets of patients who could most benefit from these novel agents. These new findings may point the way to a new era in which we can predict which patients will respond to epidermal growth factor receptor tyrosine kinase inhibitors and thus allow us to tailor therapy to the individual patient.