RADIATION AND CHEMOTHERAPY INSTEAD OF SURGERY FOR LOW INFILTRATIVE RECTAL ADENOCARCINOMA - A PROSPECTIVE TRIAL

Background: The objective of this prospective study was to determine t he possibility of treatment based exclusively on chemotherapy and radi otherapy for patients with low infiltrative rectal tumors in an attemp t to preserve sphincter function. Methods: Sixteen patients with recta l adenocarcinoma up to 3 cm above the pectineal line with initial indi cations for abdominoperineal resection (APR) were submitted to a 5040- cGy (28 x 180 cGy) radiotherapy dose and chemotherapy during the first 3 and last 3 days of radiotherapy, using 425 mg/m(2)/day of 5-fluorou racil (5FU) and 20 mg/m(2)/day of folinic acid. Levamisole was used at 150 mg/day for 3 consecutive days at 2-week intervals throughout the period of therapy. Patients with a complete response were not submitte d to APR, but received additional brachytherapy for curative purposes with doses from 2000 to 3000 cGy. Patients with recurrence after a com plete response, with partial response, or with no response were submit ted to APR. Results: Six patients (37.5%) presented a complete respons e, five (31.25%) presented a partial response, and five (31.35%) did n ot respond. The disease-free interval ranged from 1 to 34 months (mean = 11 months) among the six patients with complete response, and only one patient not submitted to APR is currently asymptomatic. Among the 15 patients with an indication for APR, three refused surgery because of full improvement of clinical symptoms and currently have tumor acti vity in the rectum. Mean patient follow-up was 23.8 months (8 to 43 mo nths), and ten patients (62.5%) showed no evidence of active disease a t last follow-up. Conclusions: The therapeutic schedule used was not e ffective in preserving sphincter function in patients with low infiltr ative rectal adenocarcinoma, because responses, although very frequent , were only temporary.