LOCAL EXCISION AND POSTOPERATIVE RADIATION-THERAPY FOR RECTAL-CANCER

Purpose: We report the results of 22 patients with localized, mobile, resectable rectal cancer treated with local excision and postoperative radiation therapy. Methods and materials. Margins were negative in 21 patients and unassessable in 1. The median follow-up was 37 months (r ange: 5-73 months). The median tumor size was 3.0 cm (range: 1-6.2 cm) . Full-thickness local excisions were performed in 21 patients: transa nal, 11; transsphincteric, 2; and posterior proctotomy (Kraske), 8. Al l margins were inked and were microscopically negative in 21. One pati ent had a transanal snare excision of a T1 polyp. Postoperatively pati ents received 4,500-4,950 cGy (median: 4,680 cGy) whole pelvis, and in 15 this was followed by a conedown to 360-1,000 cGy (median: 360 cGy) . Results, The 4-year actuarial survival was 79% and the 4-year actuar ial colostomy-free survival was 73%. The incidence of local failure wa s 18% and increased with T stage: T1: 0/4 (0%); T2: 2/12 (17%); and T3 : 2/6 (33%). Four patients developed local failure at 6, 10, 15, and 2 1 months. Of the four, three underwent salvage APR and were locally co ntrolled at 6, 33, and 58 months following salvage surgery. The incide nce of abdominal failure was 18% and distant failure was 18%. Of the 1 5 eligible patients, 14 (93%) had good or excellent sphincter function . Conclusions: The results of local excision and postoperative radiati on therapy are encouraging; however, more experience is needed to dete rmine if this approach ultimately has similar local control and surviv al rates as standard surgery.