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Postoperative Radiotherapy for Stage IIIA Rectal Cancer: Is It Justified?

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

Adjuvant radiotherapy is currently recommended for all node-positive rectal cancers to reduce local recurrence. This study evaluated if an adequate mesorectal excision can obviate the need for radiotherapy in early node-positive cancer.

Methods

Stage IIIA rectal cancer patients were identified in a prospectively maintained database. Patients who received postoperative radiotherapy (radiotherapy) and those who did not (no radiotherapy) were compared for recurrence, survival, bowel function, and quality of life. Quality of life was assessed using the Short Form-36 Medical Outcomes Survey.

Results

Eighty-six patients underwent proctectomy for T1-T2,N1 rectal cancers from 1978 to 2004. Patients receiving radiotherapy (n = 34) were younger and had a higher percentage of T1 tumors than patients who did not receive radiotherapy (n = 52). Other tumor characteristics, type of surgery, and number of involved lymph nodes were comparable. Estimated 5-year local recurrence was radiotherapy 3.4 percent and no radiotherapy 4.7 percent; distant recurrence was radiotherapy 13.5 percent and no radiotherapy 16.5 percent; and disease-specific mortality rates were similar 13.5 vs. 11.3 percent, for radiotherapy and no radiotherapy (all P > .05). Patients receiving radiotherapy had higher frequency of daytime bowel movements, urgency, and usage of pads and antidiarrheal medications. Age adjusted quality of life parameters were comparable between treatments.

Conclusion

Postoperative radiotherapy did not reduce recurrence or mortality. Function but not quality of life was adversely affected. Routine postoperative radiotherapy for Stage IIIA rectal cancer should be reconsidered.

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Acknowledgment

The authors thank Mrs. Deanna Gausse, Department of Colorectal Surgery, for her assistance with locating patients and obtaining completed questionnaires.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA

    Yehuda Kariv M.D. & Ian C. Lavery M.D.

  2. Surgery B Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Yehuda Kariv M.D.

  3. Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA

    Revital Kariv M.D.

  4. Gastroenterology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Revital Kariv M.D.

  5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA

    Jeffrey P. Hammel M.S.

Authors
  1. Yehuda Kariv M.D.
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  2. Revital Kariv M.D.
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  3. Jeffrey P. Hammel M.S.
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  4. Ian C. Lavery M.D.
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Corresponding author

Correspondence to Ian C. Lavery M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

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Kariv, Y., Kariv, R., Hammel, J.P. et al. Postoperative Radiotherapy for Stage IIIA Rectal Cancer: Is It Justified?. Dis Colon Rectum 51, 1459–1466 (2008). https://doi.org/10.1007/s10350-008-9346-9

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  • DOI: https://doi.org/10.1007/s10350-008-9346-9

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