Abstract
PURPOSE: Eighty percent of local recurrence after resection of rectal adenocarcinoma classically occurs within two years of surgery. Pretherapeutic staging is frequently limited to clinical examination, although the accuracy of endoanal ultrasonography has been demonstrated. The aim of this study was to report the long-term results of preoperative radiation therapy and resection of pretherapeutic endoanal ultrasonography–staged T3 and T4 rectal adenocarcinoma. METHODS: This retrospective review analyzed a series of 113 patients who underwent radiation therapy followed by surgery. All patients underwent an endoanal ultrasonography. Median follow-up was 75 months. RESULTS: Fifty-seven percent of patients were pT3 or T4. Thirty-six percent had involvement of lymph nodes. Five-year rates of survival, local recurrence–free survival, and disease-free survival were 79, 73, and 68 percent, respectively. Ten-year rates were 65, 63, and 62 percent, respectively. Median time to detection of local recurrence was 39 months. Eight of ten local recurrences occurred after two years of follow-up. Eight of ten patients with local recurrence had pretherapeutic endoanal ultrasonography–staged N+ tumors. CONCLUSION: These results appear to justify a follow-up program for patients with pretherapeutic endoanal ultrasonography–staged N+ tumor. However, a minimum of seven years of follow-up is needed to obtain an accurate assessment of results.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
T Holm B Cedermark LE Rutqvist (1994) ArticleTitleLocal recurrence of rectal adenocarcinoma after “curative” surgery with and without preoperative radiotherapy Br J Surg 81 452–455
GL Hill M Rafique (1998) ArticleTitleExtrafascial excision of the rectum for rectal cancer Br J Surg 85 809–812
AM Goldberg (2000) ArticleTitleRadical surgery for rectal cancer Surg Oncol Clin N Am 9 749–750
JV Reynolds WP Joyce J Dolan K Sheahan JM Hyland (1996) ArticleTitlePathological evidence in support of total mesorectal excision in the management of rectal cancer Br J Surg 83 1112–1115
J Hida M Yasutomi T Maruyama K Fujimoto T Uchida K Okuno (1997) ArticleTitleLymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method J Am Coll Surg 184 584–588
G Arbman E Nilsson O Hallbook R Sjodahl (1996) ArticleTitleLocal recurrence following total mesorectal excision for rectal cancer Br J Surg 83 375–379
JL McCall MR Cox DA Wattchow (1995) ArticleTitleAnalysis of local recurrence rates after surgery alone for rectal cancer Int J Colorectal Dis 10 126–132
E Kapiteijn CA Marijnen I Nagtegaal et al. (2001) ArticleTitleDutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–646
NR Ahmad D Nagle (1997) ArticleTitleLong-term results of preoperative radiation therapy alone for stage T3 and T4 rectal cancer Br J Surg 84 1445–1448
AG Heriot A Grundy D Kumar (1999) ArticleTitlePreoperative staging of rectal carcinoma Br J Surg 86 17–28
F Safi HG Beyer (1993) ArticleTitleThe value of follow-up after curative surgery of colorectal carcinoma Cancer Detect Prev 17 417–424
B Bohm W Schwenk HP Hucke W Stock (1993) ArticleTitleDoes methodic long-term follow-up affect survival after curative resection of colorectal carcinoma? Dis Colon Rectum 36 280–286
K Suzuki RR Dozois RM Devine et al. (1996) ArticleTitleCurative reoperations for locally recurrent rectal cancer Dis Colon Rectum 39 730–736
JR Delpero B Pol YP Le Treut et al. (1998) ArticleTitleSurgical resection of locally recurrent colorectal adenocarcinoma Br J Surg 85 372–376
HJ Wanebo RJ Koness MP Vezeridis SI Cohen DE Wrobleski (1994) ArticleTitlePelvic resection of recurrent rectal cancer Ann Surg 220 586–597
M Mohiuddin G Marks (1991) ArticleTitleHigh dose preoperative irradiation for cancer of the rectum, 1976–1988 Int J Radiat Oncol Biol Phys 20 37–43
F Bozzetti D Baratti S Andreola et al. (1999) ArticleTitlePreoperative radiation therapy for patients with T2-T3 carcinoma of the middle-to-lower rectum Cancer 86 398–404
MC Kaminsky-Forrett T Conroy E Luporsi et al. (1998) ArticleTitlePrognostic implications of downstaging following preoperative radiation therapy for operable T3-T4 rectal cancer Int J Radiat Oncol Biol Phys 42 935–941
P Rouanet B Saint-Aubert C Lemanski et al. (2002) ArticleTitleRestorative and nonrestorative surgery for low rectal cancer after high-dose radiation Dis Colon Rectum 45 305–315
TE Read OA Ogunbiyi JW Fleshman et al. (2001) ArticleTitleNeoadjuvant external beam radiation and proctectomy for adenocarcinoma of the rectum Dis Colon Rectum 44 1778–1790
TE Read MS McNevin EK Gross et al. (2001) ArticleTitleNeoadjuvant therapy for adenocarcinoma of the rectum Dis Colon Rectum 44 513–522
WE Enker N Merchant AM Cohen et al. (1999) ArticleTitleSafety and efficacy of low anterior resection for rectal cancer Ann Surg 230 544–552
M Killingback P Barron OF Dent (2001) ArticleTitleLocal recurrence after curative resection of cancer of the rectum without total mesorectal excision Dis Colon Rectum 44 473–486
Author information
Authors and Affiliations
About this article
Cite this article
Moutardier, V., Tardat, E., Giovannini, M. et al. Long-Term Results of Preoperative Radiotherapy for 113 Cases of UT3 and UT4 Rectal Cancer. Dis Colon Rectum 46, 1194–1199 (2003). https://doi.org/10.1007/s10350-004-6715-x
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-6715-x