Preoperative Versus Postoperative Radiotherapy and Chemotherapy in Locally Advanced Low Rectal Carcinoma

Abstract

The present study aimed at evaluating the treatment results of surgical resection combined with either preoperative irradiation or postoperative adjuvant irradiation plus chemotherapy in high risk locally advanced rectal carcinoma, regarding local recurrence and survival in search for clinically attainable prognostic parameter that can help in the choice of the optimum treatment modality. This study included 50 patients with locally advanced resectable rectal carcinoma having one or more of the following risk factors; partially fixed or circumferential tumor situated in the mid or low rectum, nodal involvement, penetration through the bowel wall. All the patients were treated in the radiation therapy department of the NCl, Cairo during the period from December 1994 to January 1999. Patients were randomized into 2 groups: Group 1: included 26 patients who received postoperative adjuvant chemoradiotherapy 4-6 weeks after surgery. Postoperative radiation was given to the dose of 50 Gy/5 weeks (200cGy/fraction, treating 5 days/week). Group II: included 24 patients who started by preoperative irradiation to the dose of 46Gy/4.5 weeks (200cGy/fraction, treating 5 days/week), followed in 4 weeks after completion of irradiation by surgery. The follow up time ranged from 6-53 months, with a median of 39 months. The study included 27 males and 23 females (male:female ratio = 1.2:1). Their age ranged between 15 and 59 years with a mean of 33.7 years(SD+9.3) and a median of32 years.