TREATMENT OF LOCAL RECURRENCES OF RECTAL-CARCINOMA

From 1978-1992, 159 patients were treated for local recurrences of rec tal carcinoma. They could be subdivided into three groups according to the type of primary treatment given; 82 patients underwent primary su rgery without irradiation, 37 patients had preoperative and 40 patient s postoperative radiotherapy. The localizations of the recurrences and the curative and palliative potentials of surgery and radiotherapy in the treatment of local recurrences were studied. There was no differe nce in the localisation of the recurrences in the three groups. Median time between initial surgery and recurrence was also almost the same in the three groups and 75% of the recurrences appeared within 2 years . Twenty percent of the patients in the primary surgery alone group, c ompared with 49% and 38% in the preoperative and postoperative irradia tion groups, respectively, had distant metastases at the time of the d iagnosis of local recurrence. The predominant symptom from the local r ecurrence was pain and, after treatment of the recurrence, pain relief was registered in 63%. In 66%, 16% and 22%, respectively, of the pati ents in the three groups, the intention of the treatment was curative, with either radiotherapy alone, radiotherapy combined with surgery or surgery alone. The 5-years-survival after recurrence was 6% in the pr imary surgery alone group and 0% in the other 2 groups. Of the 69 pati ents treated with a curative intention, 32% were locally symptom-free at death or the last follow-up. Our conclusion is that a local recurre nce must be avoided due to the morbidity associated with local failure and the potentially low likelihood of curative treatment of a local r ecurrence.