Adjunctive radiation therapy for rectal carcinoma

From 1977 through 1985, 113 patients received radiation therapy in conjunction with definitive surgery for adenocarcinoma of the rectum. Posttreatment consisted of a minimum follow-up of 4 years. Radiation was given as postoperative (eight patients), short-course preoperative (2,000 cGy/5 fx, 21 patients), or as full-course preoperative treatment (4,500-5,000 cGy, 84 patients). Three patients received chemotherapy as part of the adjuvant treatment. The local control for the total group was 90% (local failures, 11 of 113), and the rate of recurrence at any site (distant or local) was 30% (34 of 113). Local failure was not significantly influenced by pretreatment clinical findings, tumor grade, or surgical stage. Because of distant failures, overall recurrence was significantly associated with surgical stage-0% (0 of 15) for Astler-Coller A, 23% (7 of 30) for B1, 25% (7 of 28) for B2, and 50% (20 of 40) for B3 or C lesions (p < 0.01). Locally advanced pretreatment clinical findings were not independent of surgical stage as predictors of outcome. In particular, 14 of the tumors that received full course preoperative radiation were initially either nearly obstructing, circumferential, or deeply fixed. However, by the time of surgery, they were A or B1 lesions (probably down-staged lesions). Only one of 14 (7%) ultimately failed with a local and distant recurrence. There were four cases (3.5%) of small bowel obstruction requiring surgical management. Overall, there were 12 complications (11%) requiring either surgical or major medical management. The complication rate was not associated with radiotherapeutic factors. A strong association was noted between complications and the surgeon. Of 66 patients who had surgery with two colorectal specialists, four (6%) had serious complications. Of the remaining 47 patients who had general surgeons, eight (17%) experienced serious complications.