Local excision and adjuvant radiotherapy for rectal adenocarcinoma Tl-2N0

Aim - To study retrospectively the relapse rate, the functional results and the survival rate in patients with rectal carcinoma treated with local exc ision and adjuvant radiotherapy. Methods - Between 1980 and 1995, 43 patients were treated. All cancers were infiltrating tumours except 4 high grade dysplasias with positive margins. The pT classification was: pT1 (n = 34), pT2 (n = 4), pT3 (n = 1). In 4 ca ses the depth of penetration of the tumor into the bowel wall was not evalu able. The endo-ono( excision was performed by surgery n = 20) or by endosco py (n = 23). Only the tumor bed was irradiated in 35 cases (contact x-ray t herapy: 30, interstitial iridium implant: 5) and in 8 cases the whole rectu m was irradiated with external beam radiotherapy (+/- endocavitary irradiat ion). Results - Median follow-up was 72 months. Four malignant relapses were obse rved(focal: 1, perirectal lymphatic. 2, distant metastasis: 1). The overall 5- and 10-year survival rates were 80 and 68% respectively. A total of 41 patients preserved a normal sphincter (95%). The anal function was evaluate d as excellent or good in all the cases. No severe radiation toxicity was o bserved. Conclusion - Small rectal carcinomas T1 NO can be effectively treated in mo st cases by local excision and postoperative radiation therapy. A close mul tidisciplinary collaboration is necessary to achieve an optimal result.