Is postoperative radiotherapy useful for the rectal carcinoma in the era of total mesorectal excision?
OBJECTIVE
The exact role of postoperative radiotherapy following curative surgery of rectal carcinoma has been debated. In this retrospective study, we examined the effect of radiotherapy on the survival and recurrence rate of rectal cancer patients who underwent total mesorectal excision.


METHODS
Since June 1994, stage II and III rectal cancer patients have been recommended to receive postoperative chemoradiation. Among 175 consecutive patients who had undergone total mesorectal excision, 120 completed postoperative chemoradiation (group A) and 55 patients declined to receive radiation therapy (group B). For the two groups, survival and recurrence rates were compared. Mean follow-up time was 24.7 months. There was no difference between two groups with regard to sex, mean age, stage of the disease, mean tumor height, type of operation and mean follow-up duration.


RESULTS
Overall recurrence rate showed no difference between the two groups (24.0% vs. 25.0%, P = 0.28). Local recurrence rate was also similar (10.0% vs. 6.0%, P = 0.11). There was no significant difference in duration to initial recurrence (14.0 months vs. 11.0 months, P = 0.18). The 5-year disease-free survival was 57% in group A and 63% in group B (P = 0.33). Disease-free survival in stage II was significantly better than in stage III. (78% vs. 42% overall, 70% vs. 37% in group A, 92% vs. 44% for group B, P < 0.01).


CONCLUSIONS
In this study, we found no beneficial effect of postoperative radiation therapy following total mesorectal excision for the rectal cancer. So far, the prognosis was critically dependent on the stage rather than presence or absence of radiotherapy after total mesorectal excision.
Suh
Kwang Wook
KW
Department of Surgery, Ajou University School of Medicine, San-5 Paldal ku, Wonchon dong, Suwon 442-749, Korea. kwsuh@madang.ajou.ac.kr
Kim
Bong Wan
BW
Chun
Mison
M
Lim
Ho Young
HY
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D005472:Fluorouracil