Short-term hypofractionated radiotherapy followed by total mesorectal excision

Purpose: Is preoperative short-term radiotherapy of operable rectal carcino ma feasible with regard to early side effects and perioperative complicatio ns? Patients and Methods: As of December 1996 to March 1999, 34 patients with l ocally advanced rectal cancer have been irradiated preoperatively with 5 ti mes 5 Gy. After CT-planning, radiotherapy was administered using a 3-field or 4-field box technique with 2 anterior-posterior fields or a posterior fi eld of 9 +/- 2 cm x 11.5 +/- 2.4 cm and 2 opposed bilateral fields of 9 +/- 1.5 cm x 11.5 +/- 2 cm with 6- to 25-MV photons. Surgery was performed 14 +/- 6 days after irradiation in 33/34 patients (82% anterior resection with total mesorectal excision, 18% abdomino-perineal resection). Patients with a positive lymph node status or pT3/4 lesions underwent adjuvant chemother apy with 5-Fluorouracil (5-FU). The median follow-up period is 189 days (ra nge: 15 to 548 days). Results: The following early side reactions were registered: increased bowe l movements (4/34), fatigue (2/34), pain in the groins (1/34), nausea and p erianal smart (1/34), vertigo (1/34), temporary urinary obstruction (1/34). One patient with heart failure NYHA Grade III died of a heart attack after 21 days. Preoperative T and N categories showed a distribution of 3, 29 an d 2 for T4, T3 and unknown and 20, 11 and 3 for N+, N- and unknown; postope rative T and N categories showed a distribution of 3, 19 and 11 for T4, T3 and T2 and 19 and 14 for N+ and N-. In 32 of 33 patients tumor-free margins were achieved. One patient with peritoneal metastases had a R1 resection. In 3 patients metastases were detected intraoperatively. Perioperative comp lications were: 2 cases of leaking anastomosis and postoperative bowel aton ia. 1 case with bowel obstruction, delayed wound healing, wound dehiscence and temporary renal dysfunction. Conclusion: Preoperative radiotherapy is feasible with moderate toxicity an d is able to induce down staging despite the short time interval between ra diotherapy and surgery.