Advertisement

World Journal of Surgery

, Volume 16, Issue 1, pp 106–111 | Cite as

Pre-Operative radiotherapy as adjuvant treatment in rectal cancer

  • F. Izar
  • G. Fourtanier
  • B. Pradere
  • P. Chiotasso
  • E. Bloom
  • I. Fontes-Dislaire
  • R. Bugat
  • N. Daly
Original Scientific Reports

Abstract

From January, 1975 to December, 1987, 241 patients with rectal cancer underwent pre-operative irradiation and surgical resection. The radiation was delivered with 25 MeV photons, 5 days per week by 2.4 grays fractions up to a total dose of 36 grays. Surgery was curative in 195 patients; 57% had abdomino-perinal resection. Irradiation had to be discontinued in 3 patients and 4 patients subsequently developed severe acute ileitis. Postoperative mortality rate was 2.9%. The most frequent postoperative complications were delayed healing of abdominal wounds (18%) and perineal wounds (14%). Severe late complications occurred in 27 (13%) patients. The incidence of intestinal obstruction was 5%. Follow-up survivors ranged from 18 months to 13 years. Local failure occurred in 24 (12%) of the 195 patients. Local failure rates were 10% for Dukes' A tumors, 11.6% for Dukes' B, and 22.7% for Dukes' C tumors. Five and 10 years actuarial survival rates after curative surgery were 70% and 52%. The Dukes' classification was the only factor that influenced survival.

Keywords

Rectal Cancer Intestinal Obstruction Como Local Failure Mese 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Entre Janvier 1975 et Décembre 1987, 241 patients ayant un cancer rectal ont eu une irradiation pré-opératoire suivie de résection chirurgicale. Vingt cinq MeV ont été délivrés 5 jours par semaine par fractionnement de 7.4 Gy pour un total de 36 Gy. La chirurgie a été considérée comme curatrice chez 195 patients; 57% ont eu une amputation abdominopérinéale. Il a été nécessaire d'arrêter la radiothérapie chez trois patients et quatre patients ont développé ultérieurement une iléite radique. La mortalité postopératoire était de 2.9%. La complication la plus fréquente a été un retard de cicatrisation de la plaie abdominale ou périnéale (dans 18% et 14% des cas). Des complications tardives sont survenues chez 27 patients: 5% ont présenté une occlusion. La survie a été de 18 mois à 13 ans. Une récidive locale a été constatée chez 24 (12%) des 195 patients. La récidive locale est survenue chez 10%, 11.6% et 22.7% selon qu'il s'agissait de tumeurs de stade A, B ou C de Dukes. La survie actuarielle à 5 et à 10 ans après la chirurgie à visée curatrice était de 70 et de 52%. Seul le stade de Dukes influençait la survie.

Resumen

Doscientos cuarenta y un pacientes con cáncer rectal fueron tratados con irradiación preoperatoria y resección quirúrgica entre enero de 1975 y diciembre de 1987. La irradiación fue realizada con fotones de 25 MeV por 5 días de la semana mediante dosis fraccionadas de 2.4 grays, hasta una dosis total de 36 grays. La cirugía fue clasificada como curativa en 195 pacientes, de los cuales 57% fueron sometidos a resección abdominoperineal. La irradiación tuvo que ser descontinuada en 3 pacientes, y 4 pacientes ulteriormente desarrollaron ileitis aguda. La tasa mortalidad postoperatoria fue de 2.9%; la complicación postoperatoria más frecuente fue la cicatrización retardada de las heridas abdominal y perineal (18% y 14%). Complicaciones severas tardías se presentaron en 27 pacientes; la incidencia de obstrucción intestinal fue de 5%. El seguimiento de los sobrevivientes osciló entre 18 meses y 13 años. Falla local se presentó en 10%, 11.6% y 22.7% para los tumores Dukes A, B y C respectivamente. Las tasas de sobrevida actuarial a 5 y 10 años después de cirugía clasificada como curativa fueron 70% y 52%. La clasificación de Dukes apareció como el único factor determinante de supervivencia.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cass, A.W., Million, R.R., Pfaff, W.W. Patterns of recurrence following surgery alone for adenocarcinoma of the colon and rectum. Cancer37:2861, 1976PubMedGoogle Scholar
  2. 2.
    Rich, T., Gunderson, L.L., Lew, R., Galdibini, J.J., Cohen, A.M.: Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer52:1317, 1977Google Scholar
  3. 3.
    Gunderson, L.L., Sosin, H.: Areas of failure found at reoperation following curative surgery for adenocarcinoma of the rectum: Clinicopathologic correlation and implications for adjuvant therapy. Cancer34:1278, 1974PubMedGoogle Scholar
  4. 4.
    Stevens, K., Allen, V., Fletcher, W.S.: Preoperative radiotherapy for adenocarcinoma of the rectosigmoïd. Cancer37:2866, 1976PubMedGoogle Scholar
  5. 5.
    Higgins, G.A., Conn, J.H., Jordan, P.H., Humphrey, E.W., Roswitt, B.: Preoperative radiotherapy for colorectal cancer. Ann. Surg.181:624, 1975PubMedGoogle Scholar
  6. 6.
    Dukes, C.E.: The classification of cancer of the rectum. J. Pathol.35:323, 1932Google Scholar
  7. 7.
    Gerard, A., Buyse, M., Nordlinger, B., Loygue, J., Pene, F., Kempf, P., Bosset, J.F.: Preoperative radiotherapy as adjuvant treatment in rectal cancer: Final results of randomized study of the E.O.R.T.C. Ann. Surg.5:606, 1988Google Scholar
  8. 8.
    Higgins, G.A., Humphrey, E., Dwight, R., Roswitt, B.: Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial II. Cancer15:352, 1986Google Scholar
  9. 9.
    Pahlman, L., Glimelius, B.: Pre or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Ann. Surg.22:187, 1990Google Scholar
  10. 10.
    Hoskins, R.B., Gunderson, L.L., Dosoretz, D., Rich, A.: Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer5:61, 1985Google Scholar
  11. 11.
    Tepper, J.E., Cohen, A., Wood, W., Orlow E.: Postoperative radiation therapy of rectal cancer. Int. J. Radiat. Oncol. Biol. Phys.13:5, 1987PubMedGoogle Scholar
  12. 12.
    Shank, B., Enker, W., Morrissey, K., Daly, J., Quan, S.: Local control with preoperative radiotherapy alone versus “sandwich” radiotherapy for rectal carcinoma. Int. J. Radiat. Oncol. Biol. Phys.13:111, 1987PubMedGoogle Scholar
  13. 13.
    Pahlman, L., Glimelius, B., Graffman, S.: Pre- versus postoperative radiotherapy in rectal carcinoma: An interim report from a randomized multicenter trial. Br. J. Surg.72:961, 1985PubMedGoogle Scholar
  14. 14.
    Marks, G., Mohiuddin, M., Goldstein, S.: Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation. Int. J. Radiat. Oncol. Biol. Phys.15:1065, 1988PubMedGoogle Scholar
  15. 15.
    Stevens, K., Fletcher, W.S., Allen, W.: Anterior resection and primary anastomosis following high dose preoperative irradiation for adenocarcinoma of the recto-sigmoïd. Cancer41:2065, 1978PubMedGoogle Scholar
  16. 16.
    Stockholm Rectal Study Group: Preoperative short-term radiation therapy in operable rectal carcinoma: A prospective randomized trial. Cancer66:49, 1990Google Scholar
  17. 17.
    Moosa, A.R., Ree, C., Marks, J.E., Levin, B.: Factors influencing local recurrence after abdomino-perineal resection for cancer of the rectum. Br. J. Surg.62:727, 1975PubMedGoogle Scholar
  18. 18.
    Pelissier, E., Bosset, J.F., Mantion, G., Arbez-Gindre, F., Bouvier, J.B.: Facteurs de pronostic du cancer du rectum. Etude rétrospective sur 306 opérés. Chir.111:751, 1985Google Scholar
  19. 19.
    Astler, V.B., Coller, F.A.: The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann. Surg.139:846, 1954PubMedGoogle Scholar
  20. 20.
    Elias, D., Henry-Amar, M., Lasser, P., Gareer, W.: Cancers du rectum: Facteurs prédictifs de la survenue des récidives loco-régionales. Etude multifactorielle. Gastroenterol. Clin. Biol.9:776, 1985PubMedGoogle Scholar
  21. 21.
    Bosset, J.F., Arbez-Gindre, F., Pelissier, E., Mantion, G., Camelot, G.: Facteurs anatomo-pathologiques de pronotic des cancers du rectum. Etude mono et multifactorielle. Gastroenterol. Clin. Biol.10:728, 1986PubMedGoogle Scholar
  22. 22.
    M.R.C. Working Party: The evaluation of low dose preoperative X-ray therapy in the management of operable rectal cancer: Results of a randomly controlled trial. Br. J. Surg.71:21, 1984Google Scholar
  23. 23.
    Roswitt, B., Higgins, G.A., Keehn, R.: Preoperative irradiation for carcinoma of the rectum and recto-sigmoïd colon: Report of a National Veterans administration randomized study. Cancer35:1597, 1975PubMedGoogle Scholar
  24. 24.
    Gunderson, L.L., Russell, A., Llewellyn, H.J., Doppke, K.P.: Treatment planning for colorectal: Radiation and surgical techniques and value of small-bowel films. Int. J. Rad. Oncol. Biol. Phys.11:1379, 1985Google Scholar
  25. 25.
    Holdsworth, P.J., Johnston, D., Chalmers, A., Chennells, P.: Endoluminal ultra-sound and computed tomography in the staging of rectal cancer. Br. J. Surg.75:1019, 1988PubMedGoogle Scholar
  26. 26.
    Daly, N.J., Izar, F., Bachaud, J.M., Delannes, M.: The incidence of severe ileitis after abdominal and/or pelvic external irradiation with high energy photon beams. Radiother. Oncol.14:287, 1989PubMedGoogle Scholar
  27. 27.
    Potish, R., Twiggs, L.B., Adcock, L.L.: Logistics models for prediction of enteric morbidity in the treatment of ovarian and cervical cancers. Am. J. Obstet. Gynecol.147:65, 1983PubMedGoogle Scholar
  28. 28.
    Gastro-Intestinal Tumor Study Group: Survival after postoperative combination treatment of rectal cancer. N. Engl. J. Med.315:1294, 1986Google Scholar
  29. 29.
    Gunderson, L.L., Collins, R., Earle, J.D., Moertel, C., Krook, J., Martenson, J.: Adjuvant treatment of rectal cancer: Randomized prospective study of irradiation +/- chemotherapy: A NCCTG Study. Int. J. Radiat. Oncol. Biol. Phys.12:169, 1986Google Scholar

Copyright information

© Société Internationale de Chirurgie 1992

Authors and Affiliations

  • F. Izar
    • 1
    • 2
    • 3
  • G. Fourtanier
    • 1
    • 2
    • 3
  • B. Pradere
    • 1
    • 2
    • 3
  • P. Chiotasso
    • 1
    • 2
    • 3
  • E. Bloom
    • 1
    • 2
    • 3
  • I. Fontes-Dislaire
    • 1
    • 2
    • 3
  • R. Bugat
    • 1
    • 2
    • 3
  • N. Daly
    • 1
    • 2
    • 3
  1. 1.Departments of Radiotherapy and Medical OncologyCentre Claudius RegaudToulouseFrance
  2. 2.Department of Digestive SurgeryCentre Hospitalier Universitaire RangueilToulouseFrance
  3. 3.Department of Digestive SurgeryCentre Hospitalier Universitaire PurpanToulouseFrance

Personalised recommendations