[Adjuvant postoperative radiotherapy of rectal cancer with special reference to the problem of local recurrence]

For a longer period of time the question of indication for adjuvant postoperative radiotherapy of the rectal cancer has been discussed and handled in practice with a lot of controversy. The lymphnode status plays a very important role as an prognostic indicator for the development of the disease. This already has been shown in large collections of patient data. According to our opinion, this evidence should lead to an increase of indication of the adjuvant postoperative radiotherapy. After the introduction of the computer-aided planned, small volume four-field-technique, the former problem of an additional significant damage through adjuvant postoperative radiotherapy are no longer of importance. The life quality of living of the patient with progressive disease often shows much earlier and decisive decrease by local failure comparing a metastatic disease to the liver and lung with few symptoms over a long period of time. Our radiation therapy on 135 patients in Dukes stage B2 to C2 has shown a rate of only 7.6% local failure and in Dukes stage B an even minimaly better outcome with 5.6% compared to stage Dukes C, which expectedly shows the worst result (12.7%). The median followup of 20.4 months corresponds about to the critical 2-years period. Comparing these excellent results with the literature, one has to notice that the 5-year survival rate according to the actuarial method of Kaplan-Meier in our group is as low as 27.6% (compared to the rate of about 60% in the literature). We explain this difference with the specific age structure and the relatively high rate of distant metastasis in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)