Preoperative radiotherapy in carcinoma rectum

The present study was undertaken to address the various concerns that has limited the use of preoperative radiotherapy in rectal cancer in our institution. All patients diagnosed as having carcinoma rectum between August 2005 and July 2007 were included in the study. Group 1 patients consisted of those presenting with T2, T3 and T4 who received preoperative radiation of 25 Gy. Group 2 consisted of those with T4 tumours, who received Long course radiotherapy. Complication of radiation like dermatitis, enteritis and proctitis were noted. Before surgery CT scan and TRUS were repeated. In the postoperative period a record of abdominal, perineal wound complications and other complications were noted. The results were compared with a similar group of patients who did not receive preoperative radiotherapy. There were 21 patients (12males) with a mean age of 48.4 years (Range 18-70) in the radiotherapy group. Sixteen patients received short course (25 Gy) and five patients received long course of preoperative radiotherapy. Fourteen patients underwent definitive surgery in the form of abdominoperineal resection (APR) or anterior resection (AR). In the non-RT group there were 17 patients (8 males) with a mean age of 50.2 year. Fourteen patients underwent definitive surgery like APR (11) and AR (3). In the RT group CT scan and TRUS failed show any significant downsizing or down staging of tumour. In the RT group, incidence of acute skin toxicity was 23.8 % (5/21), all were seen in those who received long course of radiotherapy (Group 2). Grade 2 or 3 lower G I symptoms occurred in 3 (18.6 %) patients of Group 1 and 1(20 %) patient of group 2. There was higher incidence of perineal wound complication in the RT group (19.0 % vs 5.9 %). Preoperative long course of radiotherapy may be associated with high rates of dermatitis and perineal wound infection. Short course may be associated with lower G I toxicity.