[Preoperative radiochemotherapy in primary non-resectable rectal cancer].
OBJECTIVE
In a pilot-study patients with primarily non-resectable rectal cancer received a pre-operative radiochemotherapy to assess the tolerance and efficacy of this treatment protocol.


METHODS
Twenty patients with non-resectable rectal cancer (Mason CS III-IV) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50.4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m2 5-FU per day as continuous infusion over 120 hours.


RESULTS
The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor.


CONCLUSIONS
In this pilot study, pre-operative radiochemotherapy was well tolerated. The relatively high rate of curative resections and marked histological tumor regressions of this approach requires further investigations in a randomized trial.
Keilholz
L
L
Strahlentherapeutische Klinik, Universität Erlangen-Nürnberg.
Dworak
O
O
Dunst
J
J
Köckerling
F
F
Schwarz
B
B
Sauer
R
R
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012074:Remission Induction; D016896:Treatment Outcome
D005472:Fluorouracil
Präoperative Radiochemotherapie bei primär inoperablen Rektumkarzinomen.