Combined pre and postoperative radiation for carcinoma of the rectum

• Published in: International journal of radiation oncology, biology, physics Vol. 8; no. 1; pp. 133 - 136
• Main Authors: Mohiuddin, Mohammed, Kramer, Simon, Marks, Gerald, Dobelbower, Ralph R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 1982
• Subjects: Adjuvant radiotherapy; Follow-Up Studies; Humans; Liver Neoplasms - secondary; Methods; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvis; Prognosis; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Time Factors; Rectal cancer; Adjuvant radiotherapy
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(82)90398-4

Since 1976, anew approach to adjuvant radiation therapy in carcinoma of the rectum has been used at Thomas Jefferson University Hospital. Seventy-eight patients with biopsy-proven invasive carcinoma of the rectum have been treated with low dose preoperative radiation, 500 rad given either on the day of or the day before surgery. Following surgery, the lesions were pathologically staged according to Astler-Coller's Modification of Duke's staging. Patients with good prognostic features (Stage A or B 1) were followed with no further treatment while patients with poor prognostic characteristics (Stage B 2, C 1-and C 2) were treated with aggressive postoperative pelvic radiation, 4500 rad delivered in five weeks. All patients entered into this study received the preoperative dose of 500 rad. Fifty-six patients underwent an A-P resection, four patients underwent a low anterior resection and ten patients had a combined abdominal transsacral resection. Eight patients were found to have liver metastasis at laparotomy and underwent a colostomy followed by palliative therapy. Twenty-nine patients were found to have early disease, Stage A or B 1 and were given no further therapy. Of 41 patients with Stage B 2 or C, 25 patients received the full course of postoperative radiation. Sixteen patients did not receive postoperative radiation for a variety of reasons. Follow-up in these patients ranges from six months to a maximum of 48 months with a median follow-up of 18 months. Sixty-nine of the total group of 78 patients are currently alive. Two patients with early tumor (Stage A or B,) have died of metastasis. One other patient with Stage A carcinoma died of unrelated causes. Two of the 25 patients receiving postoperative radiation developed metastatic disease, but none of the patients developed local recurrence in the pelvis. Six of 16 patients who should have received postoperative radiation, but did not, recurred. Four of these six recurrences have been in the pelvis. Both the incidence of failure and the pattern of recurrence between these two groups of patients who did not receive postoperative radiation is suggestive of a better effect in the PR unrelated group. Survival of patients treated with this approach appears to be improved.