LONG-TERM FOLLOW-UP OF LOCAL EXCISION AND RADIATION-THERAPY FOR INVASIVE RECTAL-CANCER

PURPOSE: Little is known regarding the long-term outcome of patients w ith rectal cancer treated by local excision and radiation therapy. We updated our institutional experience with this approach. METHODS: From January 1986 to December 1991, 23 patients (median age, 64 (range, 30 -80) years) with mobile, moderately differentiated adenocarcinoma of t he rectum were offered transanal excision. Two patients with large T3 tumors, who were judged intraoperatively to be unsuited for a local pr ocedure, received radical resection and were excluded from analysis. T wenty-one patients underwent transanal excision en bloc (14) or piecem eal (7) through a resectoscope. Seventeen patients (74 percent) had ei ther extensive medical problems or refused a colostomy. Patients recei ved a median of 5,040 cGy post operatively, and 15 also received 500 c Gy preoperatively on protocol. Two patients received concomitant chemo therapy. Median follow-up is 56 months for all patients and 67 months for survivors (range, 27-92 months). RESULTS: There were 2 T1, 15 T2, and 4 T3 tumors. The distance from the anal verge was a median of 4 (r ange, 1-7) cm. The median tumor size was 3 (range, 2-7) cm. Sixteen pa tients had more than one-third of the wall involved. Four patients (19 percent) developed a local recurrence at 26, 30, 33, and 48 (median, 31.5) months. Three were salvaged (abdominoperineal resection = 2; low anterior resection = 1) and remain disease-free 18, 36, and 37 months postoperatively. Four patients (19 percent) developed metastases (lun g = 3; liver = 1) at 3, 22, 25, and 44 months after initial treatment (median, 23.5 months). The actuarial five-year overall, disease-free a nd recurrence-free survival are 77, 75, and 58 percent, respectively. Twelve patients (57 percent) have no evidence of disease while retaini ng their rectum. There was one postoperative death. CONCLUSIONS: Long- term follow-up confirms that local excision and radiation therapy is o f value in patients with mobile tumors of the rectum. It suggests that this treatment can be offered to those patients who refuse a colostom y or are medically compromised and may be an acceptable option for sel ected patients with T2 or T3, mobile adenocarcinomas of the rectum.