LONG-TERM RESULTS OF SELECTIVE SANDWICH ADJUNCTIVE RADIOTHERAPY FOR CANCER OF THE RECTUM

A total of 132 patients with adenocarcinoma of the rectum were treated in a program of ''selective sandwich'' adjunctive radiation therapy a nd have been followed for a minimum period of 5 years. All patients we re given a single dose of preoperative radiation, 500 cGy, either on t he day of or the day before surgery. At surgery, 12 patients with meta static disease were treated palliatively. The remaining 120 patients u nderwent radical curative surgery. Patients were then staged histopath ologically according to the Astler-Coller modification of Dukes' stagi ng: 34 patients with stage A or B1 disease were followed with no furth er treatment; 54 patients with stage B2 or C cancer received a planned course of high-dose postoperative radiation (4,500 cGy in 5 weeks); 3 2 patients with stage B2 and C cancer received no further treatment. R adiation therapy was well tolerated with few long-term side effects. N one of the patients receiving low-dose preoperative radiation alone ha d any complications. Two patients (4%) treated with the combined pre- and postoperative radiation experienced major small bowel complication s. Local recurrence was observed in 11 of 32 patients (34%) with stage B2 and C disease receiving low-dose preoperative radiation alone, as compared to 5 of 54 patients (9%) of the combined pre- and postoperati ve radiation group. The absolute 5-year survival in these two groups i s 54% and 72%, respectively. With follow-up now exceeding 5 years, the survival of patients treated with the planned approach of combined pr e- and postoperative radiation continues to remain appreciably better than for patients receiving low-dose preoperative radiation alone.