High-dose preoperative radiation and radical sphincter-preserving surgery for rectal cancer
G. Marks, M. Mohiuddin, A. Eitan, L. Masoni and J. Rakinic
Department of Surgery, Comprehensive Rectal Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pa. 19107-5098.
To reduce local recurrence associated with rectal cancer and to extend the
scope of anal sphincter preservation, a selective program of high-dose
preoperative radiation therapy and sphincter-preserving surgery was
initiated in 1976. High-energy photon therapy (40 to 60 Gy) was
administered in doses of 1.8 to 2.5 Gy during a period of 4 1/2 to 6 weeks
and followed in 4 to 6 weeks with curative sphincter-preserving surgery for
clinicopathologically unfavorable and low rectal cancers. None of the 143
patients in the study died during the postoperative period. Fifteen (13%)
of 117 patients followed up for at least 24 months experienced local
recurrence. Acceptable sphincter function was retained in 130 patients
(91%). Our program of high-dose preoperative radiation therapy and
sphincter-preserving surgery for the treatment of high-risk cancers,
including those in the distal third of the rectum, resulted in
better-than-expected survival and control of local recurrence with
acceptable morbidity and no mortality.
