[Adjunct radiotherapeutic treatment following excision of rectal cancers]

As a whole, one out of 3 rectal cancers recurs after radical surgery. With or without metastases this recurrence causes the death of the patient because, with certain exceptions, surgery and radiotherapy are not effective. Post-operative radiotherapy, if effective locally and well tolerated, should improve the results. We have treated in this fashion 50 cases (with 45 Gy in standard spread) including A 2, 3 B1, 21 B2, 1 C1 and 23 C2 of Astler-Coller classification. With a follow-up of 40 to 100 months the recurrences concern 10% of B2 and 24% of C. The actuarial survival at 5 years is 66% with 75% for B2 and 54% for C. There are 4% of severe complications in the form of 2 perineal fistulae which required surgery. There are no small bowel complications due to the precautions to protect it. A review of the literature comparing 1,366 surgical procedures alone with 339 surgical procedures combined with post-operative radiotherapy in sufficient doses, shows that the recurrence rate decreases from 34% to 12% in case of irradiation. The survivals (actuarial, gross aggregate, or without evolutive disease) show practically in all cases an improvement of survival in case of irradiation.