COMBINED PREOPERATIVE RADIATION AND MITOMYCIN 5-FLUOROURACIL TREATMENT FOR LOCALLY ADVANCED RECTAL ADENOCARCINOMA

Background: In the treatment of locally advanced rectal carcinoma, rad iation therapy before surgery has been shown to decrease local recurre nce rates, but has minimal effect on survival. Recently, chemotherapy in combination with preoperative radiation therapy has been shown to b e effective for certain malignancies. We postulated that such combinat ion therapy might improve the resectability of advanced rectal cancer. Study Design: During a 4-year period we treated 20 patients with loca lly advanced adenocarcinoma of the rectum using a protocol of preopera tive simultaneous pelvic irradiation (4,030-6,040 cGy) and infusion ch emotherapy (5-fluorouracil 100 mg/m(2) per day over 96 hours and mitom ycin 10 mg/m(2)) followed by surgical resection. Effects of therapy on resectability, tumor size, recurrence and survival, and complications of treatment were evaluated. Results: Minimal toxicity was observed a nd all patients completed their scheduled preoperative therapy. Reduct ion in tumor size after chemoradiation, as measured by CT scan, averag ed 61% (range 20-100%). Twenty percent had a complete pathologic respo nse to preoperative therapy, with no tumor found in the surgical speci men. Using Kaplan-Meier survival curves, the 5-year survival was estim ated to be 64 +/- 11%, and cancer free and local pelvic control rates were 41 +/- 12% and 88 +/- 8% respectively. Conclusions: We believe th at preoperative combination radiation and chemotherapy may provide sig nificant benefit for patients with locally advanced rectal cancer, and that further, large scale studies of this treatment regimen are warra nted. (J Am Coll Surg 1998;187: 164-170. (C) 1998 by the American Coll ege of Surgeons)