[Radiotherapy before amputation of the rectum for cancer. 100 cases]

Between 1977 and 1982, 100 patients were treated with pelvic irradiation of 3000 rads given over a 3-week period for a carcinoma located in the lower third (51 cases) or the middle third (49 cases) of the rectum. The irradiation was well tolerated by all patients. The tumour disappeared in 4 patients who were not operated upon and survived for more than 5 years. Among the remaining 96 patients, 18 of whom had fixed lesions, rectal excision was performed in 87 (90.6 per cent) and was considered curative in 75 (78 per cent). Pathological examination of the surgical specimens revealed the absence of tumour in 4 cases. There were 2 post-operative deaths. After curative excision, the 5-year survival rate was 70 per cent and the locoregional recurrence rate was 8 per cent, with perineal recurrence in only one case. Patients treated with pre-operative irradiation have been compared with a historical series of patients who had abdominoperineal excision without irradiation. In the present series of irradiated patients, thromboembolic complications were more severe, and the problems encountered with healing of the perineum were solved by changing the surgical technique in order to close the perineal wound. The rectal tumours were smaller, with a smaller proportion of tumours of more than 5 cm in diameter (P less than 0.001), but there was no significant change in Duke's stage distribution. The 5-year survival rate was higher (70 per cent versus 55.3 per cent; P less than 0.05), and the 5-year locoregional recurrence rate was lower (8 per cent versus 18.4 per cent; P less than 0.05).