Rectal carcinoma. Long‐term experience with moderately high‐dose preoperative radiation and low anterior resection

Abstract

This report updated an analysis of a 14‐year experience of moderately high‐dose (4500 to 5000 cGy) preoperative radiation as an adjuvant to low anterior resection of 95 cases of adenocarcinoma of the rectum. The treatment was well tolerated without treatment‐related mortality and with a low incidence (5.2%) of severe complications. The local recurrence rate was 4.2%, and distant failure rate was 10.5%. At 5 years, the actuarial survival rate was 66% and the disease‐free survival rate was 64%. At 10 years, the actuarial survival rate and disease‐free survival rate were 52%. The authors concluded that moderately high‐dose (4500 to 5000 cGy) neoadjuvant radiation in clinically resectable adenocarcinoma of the rectum in which one segment of the anastomosis was in the preoperative radiation field is a safe, effective adjuvant to low anterior resection and that it offered patients excellent local control, long‐term survival, and sphincter preservation. Results could be enhanced by chemotherapy, and the authors urged well‐designed prospective randomized multicenter trials to determine the most appropriate drugs, dosage, and sequencing of co‐adjuvant preoperative radiation therapy and chemotherapy with surgery. Copyright © 1992 American Cancer Society