First results of concurrent preoperative radiochemotherapy of locally advanced rectal canter

Purpose: In locally advanced rectal cancer tumor-negative margins often can not be obtained by surgery alone. Nevertheless only patients with complete tumor resection can be cured. Due to the poor prognosis of patients with R1 /R2 resection the "Deutsche Krebsgesellschaft" recommends concurrent preope rative radiochemotherapy for patients with locally advanced rectal cancer. Patients and Methods: Between May 1997 and November 1999 22 patients were t reated with preoperative radiochemotherapy. A total dose of 45 Gy with a sm all-volume boost of 5.4 Gy was delivered in conventional fractionation (sin gle dose 1,8 Gy). On days 1 to 5 and 29 to 33 patients received concurrentl y 5-fluorouracil (5-FU) as continuous infusion of 1,000 mg/m(2). If there w as any sign of cardiac toxicity chemotherapy was changed to 5-FU/folinic ac id or ralitrexed. Results: Surgery following radiochemotherapy was performed in 19/22 patient s. Resections with negative margins were achieved in 16/19 (84%) patients. Sphincter-conserving surgery was possible in 9/19 (47%) patients. A downsta ging of at least 1 T category was found in 12/19 (63%) patients. With a med ian follow-up of 16 months no locoregional recurrences occurred in patients who underwent surgery. Two-year disease-free survival of resected patients is 62%, 2-year overall survival is 89%, of the whole population 76%. Conclusion: Preoperative radiochemotherapy followed by surgery is able to a chieve clear resection margins in more than 70% of patients with locally ad vanced rectal cancer and may improve the rate of sphincter-conserving surge ry.