Aims and background: To date adjuvant treatments of rectal cancer generally include radiotherapy and more recently a combination of radiotherapy and chemotherapy. Trials have benn generally restricted to patients with stage II and III rectal cancer. The purpose of the present study is to determine the efficacy of a preoperative combination of radiation therapy and chemotherapy in operable locally advanced rectal cancer.
Methods: From March 1990 to June 1994, 58 patients with histologically documented adenocarcinoma of the rectum entered our protocol. 35 neoplasms were located in the lower third of the rectum and the remaining 23 in the middle third. At pre-treatment clinical staging 46 tumors were judged as stage III and 12 as stage II. Chemotherapy and radiotherapy were started jointly on day one of the treatment. Mitomycin-C was given as a bolus intravenous at a dosage of 10 mg/m2, the first day. 5-Fluorouracil was given in a dosage of 1000 mg./m2/day as a continuous 24 h infusion for 4 days. Radiation therapy was given at a total dosage of 37.8 Gy. Surgery was generally performed four to five weeks following completion of the radiation therapy.
Results: Patients compliance to the treatment was 96 percent. A reduction of tumor size > 50 percent was observed in 65 percent of patients. Tumor distance from anal canal increased in 75 percent of patients. Morbidity rate was 31 percent; no postoperative mortality was reported. Histological examination of surgical specimens showed that in 54 percent of patients tumor disappeared or was confined to the rectum; there was no evidence of tumor cells in 5 cases and stage I lesions were diagnosed in 19 cases (35 percent). Preliminary data on recurrences show a 5 percent local recurrence rate and a 7 percent distant metastases rate.
Conclusions: It may be concluded that preoperative radiochemotherapy is generally well tolerated; surgery does not present additional technical difficulties; the effect of stage reduction has been observed in a consistent number of cases.