Preoperative radiation therapy for patients with T2-T3 carcinoma of the middle-to-lower rectum

Abstract

BACKGROUND The aim of this study was to determine the effects of preoperative radiation therapy (RT) on the objective responses of patients with rectal carcinoma to their treatment. These effects were assessed with endorectal ultrasound (EUS) evaluation, histopathologic grading of postirradiation tumor mass reduction in the surgical specimen, and analysis of local and distant recurrences. METHODS Fifty‐nine consecutive patients with palpable adenocarcinoma of the rectum, classified by EUS examination as uT2–uT3 (which meant involvement of the muscular layer and the perirectal adipose tissue, respectively), received 45 grays (Gy) over 3 weeks (2 fractions per day of 1.5 Gy each) given as photons supplied through a high‐energy linear accelerator (18 MeV) through 3 fields: 1 posterior and 2 opposed lateral. Surgery was scheduled 2–3 weeks after the end of RT and included a sphincter‐saving resection (39 patients) and an abdominoperineal resection (20 patients). RESULTS Greatest tumor dimension, which was evaluated with rectal endoscopy before RT and measurement of the lesion in the fresh specimen, showed a decrease among two‐thirds of the patients; the decrease amounted to approximately one‐third of the initial measurement. An echoendoscopic downstaging of the T component was observed among 24.5% of the patients. Complete tumor regression occurred in 8.5% of patients, whereas in 69% only the presence of rare residual cancer cells and prominent fibrosis were found at the pathologic examination of the specimen. Finally, the tumor regressed to pT0 and pT1 in 13.6% of the patients. The overall and disease free 2‐year survival rates were 94.0% and 73.7%, respectively, for pT2 and pT3 patients, and 100% for those whose tumors regressed to pT0–pT1 after a median follow‐up of 2 years. CONCLUSIONS Hyperfractionated preoperative RT appears to be efficient in achieving tumor shrinkage and destroying the tumor. In this study, the subset of patients with a good response to RT therapy had an excellent clinical outcome at the time of a 2‐year follow‐up. Cancer 1999;86:398–404. © 1999 American Cancer Society.

Healing of experimental colonic anastomoses: Effects of combined preoperative high‐dose radiotherapy and intraperitoneal 5‐fluorouracil

“…Clinically, hyperfractionated RT (2 fractions daily of 1.5 Gy over 3 weeks with a total dose of 45 Gy) was efficient at achieving tumor shrinkage and tumor destruction [23]. In the present experiment, we used a scheme of preoperative RT identical to that used in previously reported clinical studies [24,25].…”

Mucinous carcinoma of the rectum: a distinct clinicopathological entity

“…The production of mucin without the presence of tumour cells is a common phenomenon after radiotherapy in particular [32,37,[44][45][46]. Rullier et al [38] found that 39 patients out of 200 demonstrated a colloid response to pre-operative radiotherapy, of which the vast majority (n = 34) showed no regression in tumour grade.…”

Präoperative Kurzzeitbestrahlung beim tief sitzenden Rektumkarzinom

“…Nach den Leitlinien der Deutschen Krebsgesellschaft wird deshalb eine präoperative Radiochemotherapie lediglich bei aufgrund des präoperativen Stagings oder einer Probelaparotomie als nicht kurativ (R0-)resezierbaren Tumoren empfohlen [14]. Diese Empfehlung stützt sich auf mehrere Studien, die einen entsprechenden, jedoch relativ gering ausgeprägten Vorteil nachweisen [1,17,24]. Ein Einfluss der präoperativen Bestrahlung auf die Lokalrezidivrate bei primär operablen Tumoren wird kontrovers diskutiert.…”