COLORECTAL SARCOMA - ANALYSIS OF FAILURE PATTERNS

Background and Objectives: Colorectal sarcomas (CRS) are rare and thei r treatment remains controversial, especially fur those located in the rectum. The aim of this paper is to evaluate our experience, with spe cial emphasis on the failure pattern after surgical therapy alone or c ombined with postoperative radiotherapy. Materials and Methods: The me dical records and histological slides of 13 CRS patients treated betwe en 1986 and 1996 were reviewed retrospectively. Results: The patients included eight males and five females, with a median age of 54 years; nine of their primary tumors were located in the rectum, and four in t he colon. The histologies were leiomyosarcoma in nine cases and malign ant fibrous histiocytoma in four cases. Surgical treatment consisted o f anatomical colectomy (four): local excision (three): abdominoperinea l resection (APR)(two); low anterior resection (LAR)(two): LAR en bloc with the prostate lone). and total pelvic exenteration lone). One ope rative death occurred. The median size of the tumors was 8 cm (range. 5-40). The turners were graded as low, three, and high, ten. The media n follow-up was 24 months. Eight patients in the overall group develop ed recurrences as follows: local. three; local and distant, three, and distant, two. Five out of nine patients with rectal sar coma received adjuvant postoperative radiotherapy (PRT). Local recurrence occurred in 20% (1/5) of those who received PRT, and in 100% (3/3) of those who did nor. The overall 5-year survival was 40%, and the 5-year survival for patients with low-grade tumors was 66%, as compared with 22% for those with high-grade tumors. Conclusions: The patterns of failure in CRS are combined in both local and distant sites. However, our results suggest that in rectal sarcoma, the use of surgery + PRT may reduce t he local recurrence rate; in selected patients, it may allow for anal sphincter preservation. (C) 1998 Wiley-Liss, Inc.