High-Dose Preoperative Radiation and Radical Sphincter-Preserving Surgery for Rectal Cancer

Abstract

To reduce local recurrence associated with rectal cancer and to extend the scope of anal sphincter preservation, a selective program of high-dose preoperative radiation therapy and sphincter-preserving surgery was initiated in 1976. High-energy photon therapy (40 to 60 Gy) was administered in doses of 1.8 to 2.5 Gy during a period of 4 1/2 to 6 weeks and followed in 4 to 6 weeks with curative sphincter-preserving surgery for clinicopathologically unfavorable and low rectal cancers. None of the 143 patients in the study died during the postoperative period. Fifteen (13%) of 117 patients followed up for at least 24 months experienced local recurrence. Acceptable sphincter function was retained in 130 patients (91%). Our program of high-dose preoperative radiation therapy and sphincter-preserving surgery for the treatment of high-risk cancers, including those in the distal third of the rectum, resulted in better-than-expected survival and control of local recurrence with acceptable morbidity and no mortality.

Intersphincteric resection for low rectal cancer: the risk is functional rather than oncological. A 25‐year experience from Bordeaux

“…The local recurrence rate was about 7% in a review of ISR [30], suggesting that ISR does not adversely affect patients’ oncological outcomes. In our study, the 5‐year disease‐free survival after ISR was 75%, which is in accordance with the literature [5,17,18,21–30]. These good oncological outcomes, in terms of local control and survival, are due to patient selection and surgeon experience.…”

“…In our opinion, by using neoadjuvant treatment all grades and stages of tumours may be considered for ISR except lesions with invasion of the external sphincter, intersphincteric space or levator ani muscles. Neoadjuvant chemoradiotherapy for low rectal cancer induces downsizing and downstaging that theoretically facilitates sphincter‐saving surgery, at least in experienced hands [22–28]. Our results suggest that the more frequent use of neoadjuvant chemoradiotherapy over time allowed us to decrease the distal resection margin and treat larger and more distal tumours without compromising the oncological outcomes.…”

“…Patients who had not returned questionnaires within 3 weeks were telephoned. The LARS score ranges from 0 to 42: no LARS (0-20), minor LARS (21)(22)(23)(24)(25)(26)(27)(28)(29) and major LARS (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). The continence score was 0 for normal continence and 20 for major incontinence; major incontinence was defined by a score > 10 [15], moderate incontinence 5-9 and good continence 0-4 (full continence or incontinence only to flatus).…”

Fatigue during preoperative chemoradiation for resectable rectal cancer

“…The addition of pelvic radiation, administered either before or after surgery for locally advanced rectal cancer, has improved locoregional control rates 6–12. In the Swedish Rectal Cancer Trial, the rate of local recurrence was 27% with surgery alone, 20% with postoperative radiation (60 gray [Gy] in 8 weeks), and 11% with preoperative radiation (25 Gy in 5 fractions) 8, 13–16.…”

Intersphincteric Resection Pushing the Envelope for Sphincter Preservation

“…Neoadjuvant radiochemotherapy for low rectal cancer induces downsizing and downstaging that theoretically facilitates sphincter-saving surgery, at least in experienced hands. [20][21][22][23][24][25][26] Reproducibility of such experience, however, remains questionable, as suggested by four reviews which failed to demonstrate any actual decrease in rate of APR following preoperative radiotherapy. [27][28][29][30] Some reasons could explain this discrepancy.…”