Preoperative short-term radiotherapy in rectal carcinoma. A preliminary report of a prospective randomized study

Abstract

Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short‐term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S‐group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5‐day period (RT‐group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow‐up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S‐group and 16 in the RT‐group. Fifteen patients in the S‐group had pelvic recurrence compared to 10 patients in the RT‐group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S‐group and 16 months in the RT‐group. Postoperative complications in the form of wound sepsis were slightly more common in the RT‐group. In summary, the applied treatment regimen, is well‐tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy. Cancer 55:1182‐1185, 1985.

The optimal timing for the interval to surgery after short course preoperative radiotherapy (5 ×5 Gy) in rectal cancer - are we too eager for surgery?

“…We excluded another 61 articles (reviews or inadequate data). Finally, 13 randomised trials and 31 other SCPRT studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] were included into the review with preclinical data on the timing of immune effects. The literature screening process is shown in Fig.…”

“…An increased postoperative mortality was reported in early trials [7,11,12]. Treatment volumes then reduced from L2 to mid L4 [15,16], and age limited to ≤80.…”

“…Short course preoperative radiotherapy (SCPRT) reduced the 5-year local recurrence (LR) rate in patients with rectal cancer from 27% to 11%, from 11% to 5%, and from 12% to 5% in the Swedish [1], Dutch [2][3][4], and Medical Research Council (MRC) CR07 trial [5,6] respectively, compared to surgery alone or surgery and selective postoperative radiotherapy or chemoradiotherapy. Earlier trials of SCPRT often used larger fraction sizes, larger fields and sometimes 2-field delivery [7][8][9][10][11][12][13][14][15].…”

Präoperative Kurzzeitstrahlentherapie in der chirurgischen Therapie des Rectumcarcinoms Langzeitergebnisse einer prospektiv-randomisierten Studie

“…Obwohl von einigen Autoren die Meinung vertreten wird, eine präoperative Strahlendosis unter 20 Gy hätte keine nachweisbaren Effekte für das Auftreten von Lokalrezidiven [30], zeigen andere Autoren, daû sich mit einer alleinigen präoperativen Bestrahlung von 15±20 Gy die Häufigkeit locoregionärer Rezidive senken läût [13]. der Rezidivrate und dem 5-Jahres-Überleben gefunden [2,16]. des Lokalrezidivs [14,23,32] und zum Teil auch bzgl.…”

“…Während in den ersten beiden Jahren noch die Mehrzahl der Patienten einer Rectumamputation zugeführt wurden, setzte sich in der Zeit seit 1990 der Trend der anterioren Resektion durch, und es wurden ca 2. Bei über 3 / 4 der Patienten liegt ein Nachuntersuchungszeitraum von über 5 Jahren vor.…”