CONCOMITANT PREOPERATIVE RADIOCHEMOTHERAPY IN OPERABLE LOCALLY ADVANCED RECTAL-CANCER

PURPOSE: The aim of this study was to examine the effectiveness of a c ombination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemother apy and radiotherapy are started jointly on day one of the therapy. 5- Fluorouracil is given in a dosage of 1000 mg/ m(2)/day as a continuous 24-hour infusion for 4 days. Mitomycin C is given as a bolus intraven ous at a dosage of 10 mg/m(2) the first day. The radiation therapy is given to a total dosage of 37.8 Gy. Surgery is generally performed fou r to five weeks following completion of the radiation therapy. From Ma rch 1990 to April 1933, 34 patients with histologically documented ade nocarcinoma of the rectum have been treated. Twenty-one lesions were l ocated in the lower third of the rectum. Twenty-nine neoplasms were ju dged by initial clinical staging as Stage III. RESULTS: Patients compl iance to the treatment have been 97 percent. Toxicity of treatment has been low (15 percent). Tumor sizes decreased 50 percent or more in ab out 80 percent of patients. Distance of the tumor from the anal canal increased in all but: seven cases. Twenty-two anterior resections have been performed. The morbidity rate has been 24 percent. No postoperat ive mortality has been reported. Histologic examination of surgical sp ecimens after integrated treatment showed in 10 cases a tumor confined to the rectal wall (T2), in 3 patients only a residual tumor limited to submucosa (T1), and in 5 (15 percent) patients no evidence of neopl astic cells (TO). CONCLUSIONS: We conclude that preoperative radiochem otherapy was generally well tolerated; in all cases we had a reduction of tumor sizes, surgery presented no technical difficulties, and ther e was the effect of stage reduction.