A. Bagatzounis et al., The postoperative adjuvant radiation therapy and radiochemotherapy for UICC stage II and III rectal cancer - A retrospective analysis, STRAH ONKOL, 176(3), 2000, pp. 112-117
Aim: This analysis was undertaken to review the outcome and toxicity of pos
toperative adjuvant therapy for Stage II and III rectal cancer.
Patients and Methods: We reviewed 112 patients treated with radiotherapy (4
4 patients) and radiochemotherapy (68 patients) after potentially curative
(RO) surgery for rectal cancer (UICC Stages II and III), between 1983 and 1
994 at the University Clinic of Wurzburg. Median radiation dose was 56 Gy (
range: 45 to 66 Gy). Chemotherapy consisted of 4 to 6 courses of 5-fluorour
acil (5-FU) (420 mg/m(2)/d) and leucovorin (200 mg/m(2)/d). Median follow-u
p was 37 months.
Results: The overall survival was 84% for patients with UICC Stage II and 4
5% for patients with UICC Stage III disease (p = 0.0045). There were no sta
tistically significant differences between patients treated with radiochemo
therapy vs radiotherapy in terms of 5-year survival (63% after radiochemoth
erapy vs 53% after radiotherapy, p = 0.16), relapse-free survival (52% vs 5
0%) and locoregional control (69% vs 67%). UICC Stage III disease was assoc
iated with high failure rates (40% pelvic recurrences and 53% distant metas
tases). There was a statistically significant difference in terms of the in
cidence of distant metastases between the 2 treatment modalities for patien
ts with Stage III disease (49% 5-year probability for developing distant me
tastases after radiochemotherapy vs 66% after radiotherapy, p = 0.047). In
a multivariate analysis, the addition of chemotherapy, lymph node stage and
grading were independent prognostic factors for survival. Severe late toxi
city was documented in 5% of treated patients.
Conclusions: Prognosis of patients with UICC Stage III rectal cancer remain
s poor after "standard" surgery followed by postoperative adjuvant treatmen
t (pelvic radiotherapy and bolus intravenous injection of 5-FU and leucovor
in). Major efforts should be made in order to improve prognosis for these p
atients, including optimization of surgical treatment and systemic treatmen
t. More effective multimodality treatment strategies should be investigated
in prospective randomized trials.