CONSERVATIVE MANAGEMENT OF RECTAL ADENOCARCINOMA BY RADIOTHERAPY

Purpose: The aim of this study was to analyze the experience of Centre GF Leclerc for conservative and curative treatment by radiotherapy of low rectal cancer. Patients and Methods: A total of 151 patients rece ived radiotherapy alone for rectal adenocarcinoma with curative intent . They were clinically staged according to size (T1 < 3 cm, and T2 > 3 cm) and depth of infiltration (A = superficial, and B = impaired mobi lity and T3 fixed). Over the past 6 years, rectal ultrasound (US) has been used systematically, compared with computed tomographic scan and magnetic resonance imaging when needed. Intracavitary contact X ray wa s given to 129 patients (69%), and brachytherapy in 45 of 151. Externa l radiotherapy was used in 34 cases (22.5%). Results: Complete respons e was obtained in 93%. Local failures were observed in 50 cases (28%); two occurred in pelvic nodes after intracavitary X rays. Size (tumors > 3 cm) and alteration of mobility significantly influenced the rate of local failure (p = 0.009 and 0.007). The addition of external radio therapy in patients with poor prognostic factors improved the local co ntrol rate. A total of 39 patients with recurrence were amenable to sa lvage surgery. After salvage treatment, the local control rate was 82% with unlimited follow-up. The 5-year actuarial survival rate was 57%, with a specific survival of 66%. There was no difference in local con trol or survival according to differentiation of the tumors and distan ce between anal margin and the inferior level of the lesion. Severe la te effect (grade 3) was 3.8%. The sphincter preservation was obtained in 104 of 124 cases (84%). The sphincter function was judged to normal in 102 of 104 patients (98%). Conclusion: Intracavitary contact X ray is the treatment of choice for clinical Stage T1A rectal tumors. Exte rnal radiotherapy significantly improved the results of treatment of t umors > 3 cm. Clinical staging and transrectal ultrasound allows a saf e selection of indications. Radiotherapy alone mag be proposed for sel ected cases as an alternative to mutilating surgery for small rectal a denocarcinoma. (C) 1998 Elsevier Science Inc.