RESULTS OF PREOPERATIVE INTRALUMINAL BRACHYTHERAPY COMBINED WITH RADICAL SURGERY FOR MIDDLE AND LOWER RECTAL CARCINOMAS

Background: Radiation therapy in the treatment of rectal carcinoma has received attention. We attempted to learn whether preoperative intral uminal brachytherapy (IBT) gives an advantage in local control and/or prolongation of survival. Methods: One hundred and fifteen patients wi th middle and lower rectal carcinoma with penetration into or through the rectal wall were consecutively treated with preoperative IBT and r adical operation. Patients were divided into the moderate-dose group ( group A: 16-40 Gy; n = 96) and the high-dose group (group B: 40-80 Gy; n = 19). A control group of 115 rectal carcinoma patients who receive d no radiation prier to radical surgery was compared (group C). Result s: The rate of sphincter-saving resection was 72% in group A, 63% in g roup B, and 42% in group C (group A vs. group C; P < 0.0001). The loca l recurrence rate at 5 years was 11% in group A, 6% in group B, and 26 % in group C (group A vs. group C; P = 0.005). The 5-year survival rat e was similar among the three groups. Conclusions: These results sugge sted that IBT contributed to the improvement of local control but not survival after radical resection of rectal carcinomas. The application of IBT might be useful in preserving the intestinal continuity for re ctal carcinomas. (C) 1997 Wiley-Liss, Inc.