PATTERNS OF RECURRENCE FOLLOWING PELVIC EXENTERATION AND EXTERNAL RADIOTHERAPY FOR LOCALLY ADVANCED PRIMARY RECTAL ADENOCARCINOMA

Background: Local recurrence remains the main site of failure after pe lvic exenteration for locally advanced primary rectal adenocarcinoma. This is a report on the patterns of recurrence in a group of such pati ents treated with pelvic exenteration and radiotherapy. Methods: Betwe en 1980 and 1992, we treated 49 patients. Thirty-one received preopera tive radiotherapy (pre-RT), 4.500 cGy. Six weeks later, we performed p osterior pelvic exenteration (PPE) in 21 patients, and total pelvic ex enteration (TPE) in 10. Nine patients received postoperative radiother apy (post-RT), 5,000 cGy after a PPE. Nine patients had surgery only, PPE (n=7) and TPE (n=2). Results: Surgical mortality occurred in 16% o f those patients who received pre-RT. The median follow-up was 52 mont hs. Recurrences occurred in 23% of those patients who received pre-RT (local, one; local/distant, one: distant, four); in 88% of those patie nts treated with surgery only (local/distant, four: distant, four); an d in 11% of those treated with post-RT (distant, one), The 5-year surv ival far patients who received radiotherapy was 66 versus 44% for thos e treated with surgery only. Conclusion: Local control of locally adva nced primary rectal adenocarcinoma requiring a pelvic exenteration is improved by the addition of radiotherapy. When recurrences do occur th ey are predominantly at extrapelvic sites.