Abstract
PURPOSE: The effectiveness of preoperative radiation therapy for advanced lower rectal carcinoma to preserve the function of pelvic organs and reduce local recurrences was examined in a prospective, randomized, controlled study. METHODS: Fifty-one patients with a diagnosis of localized and resectable adenocarcinoma of the lower rectum undergoing 50 Gy of preoperative radiotherapy were recruited into the trial between April 1993 and March 1995. The patients were randomly allocated to complete autonomic nerve-preserving surgery without lateral node dissection (D1), or surgery with dissection of the lateral lymph nodes including autonomic nerves (D2) followed by oral administration of carmofur for one year. RESULTS: No difference was observed in either survival or disease-free survival between D1 and D2 groups. There was no difference between the two groups in terms of recurrence rate. A significant difference was observed in urinary and sexual function (P= 0.02 and 0.02, respectively) one year after surgery between D1 and D2 groups. CONCLUSION: This study suggests that lateral node dissection is not necessary in terms of curability for patients with advanced carcinoma of the lower rectum who undergo preoperative radiotherapy.
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References
Gerard A, Buyse M, Nordlinger B,et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of randomized study (EORTC). Ann Surg 1988;208:606–14.
Stockholm Rectal Cancer Study Group. Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Cancer 1990;66:49–55.
Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997;336:980–7.
Mendenhall WM, Millon RR, Bland KI, Pfaff WW, Copeland EM. Preoperative radiation therapy for clinically resectable adenocarcinoma of the rectum. Ann Surg 1985;202:215–22.
Mohiuddin M, Marks G. Patterns of recurrence following high-dose preoperative radiation and sphincter-preserving surgery for cancer of the rectum. Dis Colon Rectum 1993;36:117–26.
Suzuki K, Muto T, Sawada T. Prevention of local recurrence by extended lymphadenectomy for rectal cancer. Surg Today 1995;25:795–801.
Moriya Y, Sugihara K, Akasu T, Fujita S. Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 1997;21:728–32.
Moriya Y, Sugihara K, Akasu T, Fujita S. Nerve-sparing surgery with lateral node dissection for advanced lower rectal cancer. Eur J Cancer 1995;31A:1229–32.
Japanese Society for Cancer Therapy. Criteria for the evaluation of the clinical effects of solid cancer radiotherapy. Nihon Gan Chiryo Gakkai Si 1993;28:101–30.
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.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Pattern of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984;53:1354–62.
Niimoto M, Hattori T, Tamada R, Sugimachi K, Inokuchi K, Ogawa N. Mitomycin C plus carmofur (HCFU) adjuvant chemotherapy for noncuratively resected cases of colorectal carcinoma. Jpn J Surg 1987;17:354–61.
Grohn P, Heinonen E, Kumpulainen E,et al. Oral carmofur in advanced gastrointestinal cancer. Am J Clin Oncol 1990;13:477–9.
Sakamoto J, Hamada C, Kodaira S, Nakazato H, Ohashi Y. Adjuvant therapy with oral fluoropyrimidines as main chemotherapeutic agents after curative resection for colorectal cancer: individual patient data meta-analysis of randomized trials. Jpn J Clin Oncol 1999;29:78–86.
Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996;182:495–502.
Little FA, Howard GC. Sexual function following radical radiotherapy for bladder cancer. Radiother Oncol 1998;49:157–61.
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Supported in part by a grant from the Ministry of Health and Welfare of Japan and in part by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan.
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Nagawa, H., Muto, T., Sunouchi, K. et al. Randomized, controlled trial of lateral node dissectionvs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44, 1274–1280 (2001). https://doi.org/10.1007/BF02234784
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DOI: https://doi.org/10.1007/BF02234784