Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders.
OBJECTIVE
To report an early analysis of prospective study exploring preoperative radiotherapy and local excision in rectal cancer.


METHODS
Mucosa at tumour edges was tattooed. Patients with cT1-3N0 tumour <3-4 cm were treated with either 5x5Gy+4Gy boost (N=31) or chemoradiation (50.4Gy+5.4Gy boost, 1.8Gy per fraction+5-fluorouracyl and leucovorin; N=13). Thirteen patients from the short-course group were unfit for chemotherapy. The interval from radiation to full-thickness local excision was 6 weeks. The protocol called for conversion to a transabdominal surgery in case of ypT2-3 disease or positive margin.


RESULTS
The postoperative complications requiring hospitalization were recorded in 9% of patients. The rate of pathological complete response was 41%. The rate of patients requiring conversion was 34%; however, 18% actually underwent conversion and the remaining 16% refused or were unfit. During the 14 months of median follow-up, local recurrence was detected in 7% of patients and all underwent salvage surgery. Of 19 patients in whom initially anterior resection was likely, 16% had abdominoperineal resection performed for a conversion or as a rescue procedure.


CONCLUSIONS
Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients.
Bujko
Krzysztof
K
Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, W.K. Roentgena 5, Warsaw, Poland. bujko@coi.waw.pl
Richter
Piotr
P
Kołodziejczyk
Milena
M
Nowacki
Marek P
MP
Kulig
Jan
J
Popiela
Tadeusz
T
Gach
Tomasz
T
Oledzki
Janusz
J
Sopyło
Rafał
R
Meissner
Wiktor
W
Wierzbicki
Ryszard
R
Polkowski
Wojciech
W
Kowalska
Teresa
T
Stryczyńska
Grazyna
G
Paprota
Krzysztof
K
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012086:Reoperation