title: Rectal carcinoma. Long-term experience with moderately high-dose preoperative radiation and low anterior resection.
abstract: This report updated an analysis of a 14-year experience of moderately high-dose (4500 to 5000 cGy) preoperative radiation as an adjuvant to low anterior resection of 95 cases of adenocarcinoma of the rectum. The treatment was well tolerated without treatment-related mortality and with a low incidence (5.2%) of severe complications. The local recurrence rate was 4.2%, and distant failure rate was 10.5%. At 5 years, the actuarial survival rate was 66% and the disease-free survival rate was 64%. At 10 years, the actuarial survival rate and disease-free survival rate were 52%. The authors concluded that moderately high-dose (4500 to 5000 cGy) neoadjuvant radiation in clinically resectable adenocarcinoma of the rectum in which one segment of the anastomosis was in the preoperative radiation field is a safe, effective adjuvant to low anterior resection and that it offered patients excellent local control, long-term survival, and sphincter preservation. Results could be enhanced by chemotherapy, and the authors urged well-designed prospective randomized multicenter trials to determine the most appropriate drugs, dosage, and sequencing of co-adjuvant preoperative radiation therapy and chemotherapy with surgery.
authors.affiliation: Department of Radiation Oncology, Halifax Medical Center, Daytona Beach, FL 32115-2830.
authors.forename: H D
authors.initials: HD
authors.lastname: Kerman
authors.forename: S H
authors.initials: SH
authors.lastname: Roberson
authors.forename: T S
authors.initials: TS
authors.lastname: Bloom
authors.forename: H C
authors.initials: HC
authors.lastname: Heron
authors.forename: T E
authors.initials: TE
authors.lastname: Yaeger
authors.forename: D L
authors.initials: DL
authors.lastname: Meese
authors.forename: A H
authors.initials: AH
authors.lastname: Ritter
authors.forename: J T
authors.initials: JT
authors.lastname: Tolland
authors.forename: A E
authors.initials: AE
authors.lastname: Spangler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis