High-dose preoperative radiation and the challenge of sphincter-preservation surgery for cancer of the distal 2 cm of the rectum

• Published in: International journal of radiation oncology, biology, physics Vol. 40; no. 3; pp. 569 - 574
• Main Authors: MOHIUDDIN, M, REGINE, W. F, MARKS, G. J, MARKS, J. W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.02.1998
• Subjects: Adult; Aged; Aged, 80 and over; Anal Canal - surgery; Biological and medical sciences; Colostomy; Combined Modality Therapy; Dose Fractionation, Radiation; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Quality of Life; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Human; Rectal disease; Stage classification; Sphincter; Malignant tumor; Radiotherapy; Conservative surgery; Treatment; Rectum; Digestive diseases; Intestinal disease; Preoperative; High dose; Survival curve
• DOI: 10.1016/S0360-3016(97)00842-0
• ISSN: 0360-3016

Sphincter-preserving surgery for the management of distal rectal cancer is gaining recognition as an alternative to abdominoperineal resection and loss of anal function. The use of high-dose preoperative radiation appears to enhance the options for sphincter preservation, even in the most distal segments of the rectum. Seventy patients with tumors located in the distal 2 cm of the rectum received a minimum dose of 40 to 45 Gy over 4 1/2 weeks at 1.8 to 2.5 Gy per fraction. Patients with unfavorable tumors were given an additional boost of 10 to 15 Gy. Surgery was performed 5 to 10 weeks following completion of radiation. Radical surgical resection was performed in 48 patients and full thickness local excision in 22. Follow-up ranged from a minimum of 1 year to a maximum of 10 years, with a median of 4 years. There was one perioperative mortality. Two patients did not have their colostomy closed because of complications. Late diversion was required in 4 patients, primarily for recurrent disease. Sixty patients (86%) maintained long-term satisfactory sphincter function. Local recurrence was observed in 9 patients (13%) and distant metastases in 12 patients (17%). The overall five-year actuarial survival rate was 82%. The 5-year survival and local recurrence for postradiation pathological stage of disease was: T0, T1, T2, N0--95% and 8%, T3, T4, N0--91% and 4%, T(any) N+--50% and 41%, respectively. High-dose preoperative radiation, in properly selected patients with rectal cancers of the distal 2 cm, offers opportunities for sphincter-preserving surgical resection with excellent local control, survival, and enhanced quality of life.