Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant radiation therapy for rectal adenocarcinoma

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

Adjuvant pelvic radiation is intended to reduce the incidence of pelvic tumor recurrence and improve the survival rates of patients who have “curative” resections for adenocarcinoma of the rectum. The results of trials of preoperative radiation of up to 2500 cGy in two weeks have been disappointing. However, studies with preoperative or postoperative radiation doses of 4500 cGy in five weeks or more suggest that the risk of pelvic recurrence can be reduced to 15 per cent or less, although follow-up in most studies is too brief to allow any comment on changes in survival rates. These promising results need to be confirmed, since most were not obtained in appropriately controlled studies. Although these higher radiation doses do appear to be safe when attention is paid to surgical and radiotherapy techniques, this also needs to be confirmed with larger numbers of patients and longer follow-up. While the studies suggest that higher radiation doses are more effective than lower doses, there is no agreement on whether radiation should be directed to the region of the primary tumor only, or also to the pelvic lymph nodes, nor whether radiation should be given before or after surgery. Although the use of adjuvant pelvic radiation is becoming more widespread, these and other questions need to be answered before adjuvant radiation can be considered standard therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pilipshen SJ, Heilweil M, Quan SHQ, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resection of rectal cancer. Cancer 1984;53:1354–62.

    Article  PubMed  CAS  Google Scholar 

  2. Gunderson LL, Tepper JE, Dosoretz DE, et al. Patterns of failure after treatment of gastrointestinal cancer. Cancer Treat Symp 1983;2:181–97.

    Google Scholar 

  3. Perez CA. Preoperative irradiation in the treatment of cancer. Experimental observations and clinical implications. Front Radiat Ther Oncol 1970;5:1–29.

    Google Scholar 

  4. Rich T, Gunderson LL, Lew R, Galdibini JJ, Cohen AM, Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer 1983;52:1317–29.

    Article  PubMed  CAS  Google Scholar 

  5. Withers HR, Cuasay L, Mason KA, Romsdahl MM, Saxton J. Elective radiation therapy in the curative treatment of cancer of the rectum and rectosigmoid colon. In: Stroehlein JR, Romsdahl MM, eds. Gastrointestinal cancer. New York: Raven Press, 1981:351–62.

    Google Scholar 

  6. Welch JP, Donaldson GA. The clinical correlation of an autopsy study of recurrent colorectal cancer. Ann Surg 1979;189:496–502.

    Article  PubMed  CAS  Google Scholar 

  7. McPherson TA, Brzezinski WS, Young D, Harbora D. Adjuvant chemoimmuno- and immunotherapy in B2 and C colorectal cancer: a single center, population-based study (in press).

  8. Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:613–6.

    PubMed  CAS  Google Scholar 

  9. Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications of adjuvant therapy. Cancer 1974;34:1278–92.

    Article  PubMed  CAS  Google Scholar 

  10. Stearns MW Jr, Deddish MR, Quan SH. Preoperative roentgen therapy for cancer of the rectum. Surg Gynecol Obstet 1959;109:225–9.

    PubMed  Google Scholar 

  11. Rider WD, Palmer JA, Mahoney LJ, Robertson CT. Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. Can J Surg 1977;20:335–58.

    PubMed  CAS  Google Scholar 

  12. Stearns MW Jr. Pre- or postoperative radiation in resectable tumors. In: Welvaart K, Blumgart LH, Kreuning J, eds. Colorectal cancer. The Hague: Leiden University Press 1980:153–9.

    Google Scholar 

  13. Higgins GA Jr, Conn JH, Jordan PH Jr, Humphrey EW, Roswit B, Keehn RJ. Preoperative radiotherapy for colorectal cancer. Ann Surg 1975;181:624–31.

    Article  PubMed  Google Scholar 

  14. Second Report of an MRC Working Party. The evaluation of low dose pre-operative x-ray therapy in the management of operable rectal cancer: results of a randomly controlled trial. Br J Surg 1984;71:21–5.

    Google Scholar 

  15. Papillon J. New prospects in the conservative treatment of rectal cancer. Dis Colon Rectum 1984;27:566–7.

    Google Scholar 

  16. Kligerman MM. Radiotherapy and rectal cancer. Cancer 1977;39:896–900.

    Article  PubMed  CAS  Google Scholar 

  17. Pujol H, Solassol C, Gary-Bobo J, et al. La radiothérapie préoperatoire des cancers du rectum, actualisation des résultats. A propos de 179 cas. Chirurgie 1978;104:606–11.

    PubMed  CAS  Google Scholar 

  18. Gary-Bobo J, Pujol H, Solassol C, Broquerie JL, Nguyen M. L'irradiation préopératoire du cancer rectal. Résultats à 5 ans de 116 cas. Bull Cancer 1979;66:491–6.

    PubMed  CAS  Google Scholar 

  19. Stevens KR Jr, Fletcher WS, Allen CV. A review of the value of radiation therapy for adenocarcinoma of the rectum and sigmoid. Front Gastrointest Res 1979;5:93–101.

    PubMed  Google Scholar 

  20. Nias AHW. Radiobiological aspects of pre-operative irradiation. Br J Radiol 1967;40:166–9.

    Article  PubMed  CAS  Google Scholar 

  21. Fletcher GH. Clinical dose response curve of subclinical aggregates of epithelial cells and its practical application in the management of human cancers. In: Friedman M, ed. Biological and clinical basis of radiosensitivity. Springfield, Illinois: Charles C Thomas 1973:485–501.

    Google Scholar 

  22. Rodríguez-Antúnez A, Chernak ES, Jelden GL, Hunter TW. Preoperative irradiation of carcinoma of the rectum. Radiology 1973;108:89–90.

    Google Scholar 

  23. Cummings BJ, Rider WD, Harwood AR, Keane TJ, Thomas GM. Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum 1983;26:30–6.

    PubMed  CAS  Google Scholar 

  24. MRC Working Party. A trial of preoperative radiotherapy in the management of operable rectal cancer. Br J Surg 1982;69:513–9.

    Google Scholar 

  25. Wright H. Comments on adjuvant radiation therapy in colorectal carcinoma. Am J Surg 1978;135:518.

    Google Scholar 

  26. Higgins GA, Humphrey EW, Juler GL, Roswit B, Keehn RJ. Adjuvant therapy for rectal cancer. Update of Veterans Administration Surgical Oncology Group Trials. In: Gérard A, ed. Progress and perspectives in the treatment of gastrointestinal tumors. Oxford: Pergamon Press, 1981:62–7.

    Google Scholar 

  27. Leaming R. Radiation therapy in the clinical management of neoplasms of the colon, rectum and anus. In: Stearns MW Jr ed. Neoplasms of the colon, rectum, and anus. New York: John Wiley & Sons, 1980:143–53.

    Google Scholar 

  28. Glimelius B, Graffman S, Pahlman L, Rimsten A, Wilander E. Preoperative irradiation with high-dose fractionation in adenocarcinoma of the rectum and rectosigmoid. Acta Radiol Oncol 1982;21:373–9.

    PubMed  CAS  Google Scholar 

  29. Roberson SH, Heron HC, Kerman HE, Bloom TS. Is anterior resection of the rectosigmoid safe after preoperative radiation? Dis Colon Rectum 1984;27:565–6.

    Google Scholar 

  30. Stevens KR Jr, Fletcher WS, Allen CV. Anterior resection and primary anastomosis following high dose preoperative irradiation for adenocarcinoma of the recto-sigmoid. Cancer 1978;41:2065–71.

    Article  PubMed  Google Scholar 

  31. Blake DP, Bubrick MP, Kochsiek GC, et al. Low anterior anastomotic dehiscence following preoperative irradiation with 6000 rads. Dis Colon Rectum 1984;27:176–81.

    PubMed  CAS  Google Scholar 

  32. Newman HK, Stearns MW Jr. Re-exploration for “unresectable” colonic cancer. Dis Colon Rectum 1975;18:576–80.

    PubMed  CAS  Google Scholar 

  33. Tierie AH. Radiotherapy in marginal resectable and non-resectable rectum cancer. Radiol Clin 1978;47:222–7.

    CAS  Google Scholar 

  34. Emami B, Pilipich M, Willett C, Munzenrider JE, Miller HH. Effect of preoperative irradiation on resectability of colorectal carcinomas. Int J Radiat Oncol Biol Phys 1982;8:1295–9.

    PubMed  CAS  Google Scholar 

  35. Mittelman A, Holyoke E, Thomas PRM, et al. Adjuvant chemotherapy and radiotherapy following rectal surgery: an interim report from the Gastrointestinal Tumor Study Group (GITSG). In: Salmon SE, Jones SE, eds. Adjuvant therapy of cancer III. New York: Grune and Stratton, 1981;547–57.

    Google Scholar 

  36. Balslev I, Pedersen M, Teglbjaerg PS, et al. Postoperative radiotherapy in rectosigmoid cancer Dukes' B and C: interim report from a randomized multicentre study. Br J Cancer 1982;46:551–6.

    PubMed  CAS  Google Scholar 

  37. Withers HR, Romsdahl M, Barkley HT Jr, Saxton J, McBride C, McMurtrey M. Post-operative radiotherapy for rectal cancer. In: Jones SE, Salmon SE, eds. Adjuvant therapy of cancer II. New York: Grune and Stratton, 1979:621–8.

    Google Scholar 

  38. Hoskins B, Gunderson LL, Dosoretz D, et al. Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer (in press).

  39. Mohuiddin M, Kramer S, Marks G, Dobelbower RR. Combined pre and postoperative radiation for carcinoma of the rectum. Int J Radiat Oncol Biol Phys 1982;8:133–6.

    Google Scholar 

  40. Gunderson LL, Dosoretz DE, Hedberg SE, et al. Low-dose preoperative irradiation, surgery, and elective postoperative radiation therapy for resectable rectum and rectosigmoid carcinoma. Cancer 1983;52:446–51.

    Article  PubMed  CAS  Google Scholar 

  41. Gilbert JM. Adjuvant chemotherapy of large bowel cancer. Cancer Treat Rev 1982;9:195–228.

    Article  PubMed  CAS  Google Scholar 

  42. Enker WE, Kemeny N, Shank B, Rotstein L. Defining the needs for adjuvant therapy of rectal and colonic cancer. Surg Clin North Am 1981;61:1295–1310.

    PubMed  CAS  Google Scholar 

  43. Gérard A. La radiotherapie préopératoire des cancers du rectum. Ch 15 in Progres en Cancerologie I, ed. Zeitoun P, Doin Ed., Paris, 1981:169–178.

    Google Scholar 

  44. Buroker T, Nigro N, Correa J, Vaitkevicius VK, Samson M, Considine B. Combination preoperative radiation and chemotherapy in adenocarcinoma of the rectum: preliminary report. Dis Colon Rectum 1976;19:660–3.

    Google Scholar 

  45. Sischy B, Remington JH, Sobel SH, Savlov ED. Treatment of carcinoma of the rectum and squamous carcinoma of the anus by combination chemotherapy, radiotherapy and operation. Surg Gynecol Obstet 1980;151:369–71.

    PubMed  CAS  Google Scholar 

  46. Robinson E, Bartal A, Cohen Y, Hairn N, Mohilever J, Mekori T. Combined adjuvant therapy of radically operated colorectal cancer patients. (Chemotherapy, radiotherapy, and MER-BCG). Cancer Chemother Pharmacol 1982;8:35–40.

    Article  PubMed  CAS  Google Scholar 

  47. Angell M. Patient's preferences in randomized clinical trials. N Engl J Med 1984;310:1385–7.

    Article  PubMed  CAS  Google Scholar 

  48. Localio SA, Nealon W, Newall J, Valensi Q. Adjuvant postoperative radiation therapy for Dukes C adenocarcinoma of the rectum. Ann Surg 1983;198:18–24.

    Article  PubMed  CAS  Google Scholar 

  49. Feinstein AR, Schimpff CR, Hull EW. A reappraisal of staging and therapy for patients with cancer of the rectum: I. Development of two new systems of staging. Arch Intern Med 1975;135:1441–53.

    Article  PubMed  CAS  Google Scholar 

  50. Zorzitto M, Germanson T, Cummings B, Boyd NF. A method of clinical prognostic staging for patients with rectal cancer. Dis Colon Rectum 1982;25:759–65.

    PubMed  CAS  Google Scholar 

  51. Nicholls RJ, York Mason A, Morson BC, Dixon AK, Kelsey Fry I. The clinical staging of rectal cancer. Br J Surg 1982;69:404–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, The Princess Margaret Hospital, 500 Sherbourne Street, M4X 1K9, Toronto, Ontario, Canada

    B. J. Cummings M.B., Ch.B., F.R.C.P.(C), F.R.C.R., M.R.A.C.R.

Authors
  1. B. J. Cummings M.B., Ch.B., F.R.C.P.(C), F.R.C.R., M.R.A.C.R.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Cummings, B.J. Adjuvant radiation therapy for rectal adenocarcinoma. Dis Colon Rectum 27, 826–836 (1984). https://doi.org/10.1007/BF02553949

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02553949

Key words

Search

Navigation