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Preoperative Radiation Therapy for Rectal Cancer: An Effective Therapy in Need of a Clinical Trial

Preoperative Radiation Therapy for Rectal Cancer: An Effective Therapy in Need of a Clinical Trial Abstract • Sixty patients with locally advanced adenocarcinoma of the rectum have been treated with preoperative high-dose pelvic irradiation in an attempt to improve operability and increase local control. Fifty-six patients showed no evidence of distant metastases at surgery and their records have been analyzed with respect to recurrence patterns, survival, and complications. The results have been compared with those of a similar analysis of 106 patients treated with curative surgery alone. There was a statistically significant improvement in local control between groups, with 16% of patients in the radiotherapy group having a component of local failure compared with 40% in the surgery group. A dose response was observed, with 67% local control at 4000 rad (4000 cGy) and 91% local control at 5000 rad (5000 cGy). Despite the more advanced clinical stage of the irradiated patients, no significant difference in survival was seen between groups, with a five-year survival rate of 52% in the irradiated patients and 48% in patients treated by surgery alone. Preoperative high-dose radiotherapy was well tolerated, with a 5% incidence of major complications in both groups. (Arch Surg 1986;121:1380-1385) References 1. Gastrointestinal Tumor Study Group: Prolongation of the disease-free interval in surgically treated rectal cancer . N Engl J Med 1985;312:1465-1473.Crossref 2. Hoskin RB, Gunderson LL, Dosoretz DE, et al: Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid . Cancer 1985;55:61-71.Crossref 3. Dukes CE: The classification of cancer of the rectum . J Pathol Bacterial 1932;35:323-332.Crossref 4. Fortier GA, Krochak RJ, Kim JA, et al: Dose response to preoperative irradiation in rectal cancer: Implications for local control and complications associated with sphincter-sparing surgery and abdominoperineal resection. Int J Radiat Oncol Biol Phys, in press. 5. Kligerman MM, Urdaneta N, Knowlton A, et al: Preoperative irradiation of rectosigmoid carcinoma including its regional lymph nodes . AJR 1972;114:498-503.Crossref 6. Rider WD, Palmer JA, Mahoney LJ, et al: Preoperative irradiation in operable cancer of the rectum: Report of the Toronto trial . Can J Surg 1971;20:335-338. 7. Roswit B, Higgins GA, Keehn RJ: Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: Report of a national Veterans Administration randomized study . Cancer 1975;35:1597-1602.Crossref 8. Cedermark B, Theve NO, Rieger A, et al: Preoperative short-term radiotherapy in rectal carcinoma . Cancer 1985;55:1182-1185.Crossref 9. Second report of an MRC working party: The evaluation of low dose preoperative x-ray therapy in management of operable rectal cancer: Results of a randomly controlled trial . Br J Surg 1984;71:21-25.Crossref 10. Stearns MW, Deddish MR, Quan SHQ, et al: Preoperative roentgen therapy for cancer of the rectum and rectosigmoid . Surg Gynecol Obstet 1974;138:584-586. 11. Roberson SH, Heron HC, Kerman HD, et al: Is anterior resection of the rectosigmoid safer after preoperative radiation? Dis Colon Rectum 1985;28:254-259.Crossref 12. Stevens KR, Fletcher WS, Allen CV: Anterior resection and primary anastomosis following high dose preoperative irradiation for adenocarcinoma of the rectosigmoid . Cancer 1978;41:2065-2071.Crossref 13. Stevens KR, Allen CV, Fletcher WS: Preoperative radiotherapy for adenocarcinoma of the rectosigmoid . Cancer 1976;37:2866-2874.Crossref 14. Pilepich MV, Munzenrider JE, Tak WK, et al: Preoperative irradiation of primarily unresectable colorectal carcinoma . Cancer 1978;42:1077-1081.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Preoperative Radiation Therapy for Rectal Cancer: An Effective Therapy in Need of a Clinical Trial

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1986.01400120026003
Publisher site
See Article on Publisher Site

Abstract

Abstract • Sixty patients with locally advanced adenocarcinoma of the rectum have been treated with preoperative high-dose pelvic irradiation in an attempt to improve operability and increase local control. Fifty-six patients showed no evidence of distant metastases at surgery and their records have been analyzed with respect to recurrence patterns, survival, and complications. The results have been compared with those of a similar analysis of 106 patients treated with curative surgery alone. There was a statistically significant improvement in local control between groups, with 16% of patients in the radiotherapy group having a component of local failure compared with 40% in the surgery group. A dose response was observed, with 67% local control at 4000 rad (4000 cGy) and 91% local control at 5000 rad (5000 cGy). Despite the more advanced clinical stage of the irradiated patients, no significant difference in survival was seen between groups, with a five-year survival rate of 52% in the irradiated patients and 48% in patients treated by surgery alone. Preoperative high-dose radiotherapy was well tolerated, with a 5% incidence of major complications in both groups. (Arch Surg 1986;121:1380-1385) References 1. Gastrointestinal Tumor Study Group: Prolongation of the disease-free interval in surgically treated rectal cancer . N Engl J Med 1985;312:1465-1473.Crossref 2. Hoskin RB, Gunderson LL, Dosoretz DE, et al: Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid . Cancer 1985;55:61-71.Crossref 3. Dukes CE: The classification of cancer of the rectum . J Pathol Bacterial 1932;35:323-332.Crossref 4. Fortier GA, Krochak RJ, Kim JA, et al: Dose response to preoperative irradiation in rectal cancer: Implications for local control and complications associated with sphincter-sparing surgery and abdominoperineal resection. Int J Radiat Oncol Biol Phys, in press. 5. Kligerman MM, Urdaneta N, Knowlton A, et al: Preoperative irradiation of rectosigmoid carcinoma including its regional lymph nodes . AJR 1972;114:498-503.Crossref 6. Rider WD, Palmer JA, Mahoney LJ, et al: Preoperative irradiation in operable cancer of the rectum: Report of the Toronto trial . Can J Surg 1971;20:335-338. 7. Roswit B, Higgins GA, Keehn RJ: Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: Report of a national Veterans Administration randomized study . Cancer 1975;35:1597-1602.Crossref 8. Cedermark B, Theve NO, Rieger A, et al: Preoperative short-term radiotherapy in rectal carcinoma . Cancer 1985;55:1182-1185.Crossref 9. Second report of an MRC working party: The evaluation of low dose preoperative x-ray therapy in management of operable rectal cancer: Results of a randomly controlled trial . Br J Surg 1984;71:21-25.Crossref 10. Stearns MW, Deddish MR, Quan SHQ, et al: Preoperative roentgen therapy for cancer of the rectum and rectosigmoid . Surg Gynecol Obstet 1974;138:584-586. 11. Roberson SH, Heron HC, Kerman HD, et al: Is anterior resection of the rectosigmoid safer after preoperative radiation? Dis Colon Rectum 1985;28:254-259.Crossref 12. Stevens KR, Fletcher WS, Allen CV: Anterior resection and primary anastomosis following high dose preoperative irradiation for adenocarcinoma of the rectosigmoid . Cancer 1978;41:2065-2071.Crossref 13. Stevens KR, Allen CV, Fletcher WS: Preoperative radiotherapy for adenocarcinoma of the rectosigmoid . Cancer 1976;37:2866-2874.Crossref 14. Pilepich MV, Munzenrider JE, Tak WK, et al: Preoperative irradiation of primarily unresectable colorectal carcinoma . Cancer 1978;42:1077-1081.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 1986

References