Neoadjuvant Radiotherapy in Stage I Cancer of the Lower Rectum

Abstract

Introduction: The mortality rate in cancer of the lower rectum is related to the incidence of local recurrence, in the first 5 years. For stage I tumors, local excision has being increasingly used, but recent studies showed a higher incidence rate of local recurrence. Therefore, preoperative radiotherapy should be considered even for these tumors, as an attempt to prevent recurrence and provide cure. Objective: To show the effectiveness of neoadjuvant radiotherapy in stage I cancer of the lower rectum of a cohort population. Materials and Method: A cohort study in a prospective database was made with a total of 75 patients considered as stage I cancer of the lower rectum. Preoperative long course of 4500 cG radiotherapy was performed in this selected group of patients and followed up for a minimum period of five years. Results: Stage I/TI group had 27 patients. All of them presented complete response to the treatment and did not need to be submitted to surgery. Five years follow up with no recurrence. The stage I/TII group had 48 patients. After neoadjuvant radiotherapy, 8 patients had to be submitted to surgery for persistent tumor. All were submitted to full total local excision (FTLE), but anatomopathological examination showed no residual cancer. Conclusion: Preoperative long course of 4500 cG irradiation, not only reduced the local recurrence and mortality rate in lower rectal cancer, but also reduced indication for surgery in patients with stage I cancer of the lower rectum.