Adjuvant radiation therapy for locally advanced rectal cancer

One hundred and twelve patients with locally advanced adenocarcinoma of the rectum have been treated with a protocol of adjuvant radiotherapy from 1981 to 1989. Radiotherapy was administered with a 'sandwich' method at a dosage of 2700 cGy preoperatively and of 1800 cGy postoperatively. Only patients in stages B and C have been considered for results. Postoperative morbidity has been 16% and postoperative mortality 2.7%. Local failure was seen in 20% of patients without significant differences by stage, location, grading and operative technique. Distant metastases were seen in 31% of patients. Five-year actuarial survival was 49% and respectively 58% in stage B and 38% in stage C (p>0.01). Compared with a series of historical controls treated with surgery alone, the local recurrence rate was 20% vs 26%, the distant metastases rate was 31% vs 38% and the five-year actuarial survival rate was 49% vs 36% (p>0.01).