The postoperative adjuvant radiation therapy and radiochemotherapy for UICC stage II and III rectal cancer - A retrospective analysis

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.