PREOPERATIVE IRRADIATION AND FLUOROURACIL CHEMOTHERAPY FOR LOCALLY ADVANCED RECTOSIGMOID CARCINOMA - PHASE I-II STUDY

From June 1988 to July 1991, 20 patients with locally advanced rectal or rectosigmoid cancer were treated prospectively with a strategy of c ombining preoperative irradiation and fluorouracil chemotherapy before surgical resection. The preoperative radiation dose was 5,000 cGy, an d fluorouracil chemotherapy was administered on the first and last 3 d ays of irradiation in an intravenous bolus dose of 500 mg/m2. In a med ian follow-up of 25 months, the local regional failure rate was 10%. T he 3-year actuarial overall survival and disease-free survival were 92 % and 82%, respectively. Twenty percent of the surgical specimens show ed no residual tumor, and only 10% showed positive lymph nodes. Signif icant leukopenia occurred in 10% of patients. Preoperative irradiation and fluorouracil chemotherapy increased surgical downstaging and impr oved local regional control. The overall toxicity was acceptable. The results of this particular multimodality approach are encouraging and warrant further investigation in phase III trials.