Preoperative irradiation for unresectable rectal and rectosigmoid carcinomas

Abstract

The records of 25 patients with unresectable carcinoma of the rectum and rectosigmoid who received preoperative radiation therapy (RT) were reviewed. Twenty patients were considered to be resectable following RT (80%). Sixteen patients (64%) underwent curative resections. All patients with unresectable tumors following RT died with tumor within two and one half years (median survival, 11 months). For patients undergoing curative resection, the probability of two‐ and five‐year survival was 56% and 43%, respectively. In this latter group, five of seven patients with treatment failures (71%) had a pelvic component of disease. The incidence of pelvic recurrence was correlated with the pathologic stage, extent of resection and preoperative radiation dose. The need for more aggressive treatment for patients with these advanced tumors is emphasized. Future treatment alternatives are discussed.

Preoperative Radiotherapy Improves Outcome in Recurrent Rectal Cancer

“…7,[25][26][27][28] The use of preoperative radiotherapy in the treatment of recurrent rectal cancer with curative intent is based on studies in primary rectal cancer that identify a beneficial effect of radiation therapy on the resectability, local control, and even overall survival. 29,30 However, there are no good comparative data from prospective trials in recurrent rectal cancer. In this article, we have focused on the effects of preoperative radiotherapy, without adjuvant chemotherapy.…”

Preoperative Radiation with Concurrent 5-Fluorouracil for Locally Advanced T4-Primary Rectal Cancer

“…If compared to historical radiotherapy-alone series in which rates of resectability between 40 and 88%, local failure rates between 7 and 50% and 5-year survival rates of 12 to 34% have been published [4,11,13], all these studies suggest that combined-modality treatment with 5-FU-based CT and radiotherapy are more effective in terms of tumor downstaging, resectability, local control and long-term survival. Interestingly, data from the 1960s had already shown a survival advantage for patients with locally unresectable rectal cancer treated with combined radiotherapy and 5-FU vs those treated with radiotherapy alone [21].…”

Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma

“…1,14–18 Local recurrence rates, even after combined EBRT and extensive pelvic surgery, are approximately 50 %. 19,20 The morbidity of uncontrolled pelvic disease is frequently significant. As a result, a multimodal approach has evolved to aggressively treat these problematic tumors.…”