IMPROVED SURVIVAL WITH PREOPERATIVE RADIOTHERAPY IN RESECTABLE RECTAL-CANCER

Background Adjuvant radiotherapy for rectal cancer has been extensivel y studied, but no trial has unequivocally demonstrated improved overal l survival with radiotherapy, despite a reduction in the rate of local recurrence. Methods Between March 1987 and February 1990, we randomly assigned 1168 patients younger than 80 years of age who had resectabl e rectal cancer to undergo preoperative irradiation (25 Gy delivered i n five fractions in one week) followed by surgery within one week or t o have surgery alone. Results The irradiation did not increase postope rative mortality. After five years of follow-up, the rate of local rec urrence was 11 percent (63 of 553 patients) in the group that received radiotherapy before surgery and 27 percent (150 of 557) in the group treated with surgery alone (P<0.001). This difference was found in all subgroups defined according to Dukes' stage. The overall five-year su rvival rate was 58 percent in the radiotherapy-plus-surgery group and 48 percent in the surgery-alone group (P=0.004). The cancer-specific s urvival rates at nine years among patients treated with curative resec tion were 74 percent and 65 percent, respectively (P=0.002). Conclusio ns A short-term regimen of high-dose preoperative radiotherapy reduces rates of local recurrence and improves survival among patients with r esectable rectal cancer. (C) 1997, Massachusetts Medical Society.