Pre-versus postoperative chemoradiation combined with total mesorectal excision in locally advanced carcinoma of the low rectum

Abstract EN

Purpose : Total mesorectal excision (TME) had been established as the standard of care for resection of carcinoma of the rectum, resulting in reduction of the pelvic recurrence rate from 22% to 8.2% [1].

The addition of adjuvant chemo radiation further reduces local recurrence rate, yet the impact on the overall survival is not unequivocally demonstrated.

The timing of irradiation also, remains as an unanswered question.

Patients and methods : This is a prospective randomized clinical study including patients with locally advanced low rectal cancer treated at the NCI Cairo University, during the period from Dec.

1994 to Jan.

1999.

The study included 50 patients with previously untreated low rectal cancer.

Patients were randomized into two groups, Group I: subjected to surgery followed by radiation therapy (50Gy / 5 weeks, 200 cGy / fraction, 5 days / week) plus chemotherapy and Group II, subjected to preoperative radiotherapy (46Gy / 4.5 weeks, 200 cGy / fraction, 5 days / week) followed by surgery plus chemotherapy.

Results: Loco regional recurrence rate was 4 % in group I and 2 % in group II.

The actuarial 4-year survival in group II was better than group I (81 % versus 58 %), yet this difference was not statistically significant (p = 0.49).

Also the 4 year disease free survival in group II was better than grade I (58.2 % versus 35.8 %), yet this difference was not statistically significant (p = 0.41).

Conclusions : this work showed that there is a trend for better results with preoperative chemo radiation, yet it did not reach a statistically significant value.

More patients with longer follow up are needed to reach significant values.