[Preoperative short-term irradiation in rectal cancer]

From 1979 through 1983, 78 patients underwent short-term preirradiation before primary operation for rectal carcinoma at the Medical Radiation Institute of Tübingen. A hyperfractionated total dose of 16 Gy was applied within a maximum time of 36 hours in four fractions of 4 Gy each. Surgery was performed at the last irradiation day. The medium observation time of the total group of patients was five years and three months, at least 40 months. The local recurrence rate of all patients followed up is 9% (7/78), for stage Dukes A it is 6% (2/32), for stage Dukes B 0%(0/25), for stage Dukes C 27% (3/11), and for stage Dukes D 20% (2/10). In the group of 68 patients showing no metastases at the moment of surgery, the rate of formation of remote metastases amounts to 21%, in stage Dukes A to 13% (4/32), in stage Dukes B to 24% (6/25), and in stage Dukes C to 36% (4/11). The relapse-free survival during the follow-up period is 66% (45/68), for stage Dukes A 69% (22/32), for stage Dukes B 68% (17/25), and for stage Dukes C 55% (6/11). There were no acute or late radiogenic complications. Compared to publications about cases treated only by surgery, the present preirradiated patient's group shows a considerable lower local recurrence rate and an increased relapse-free survival rate. These improved treatment results are probably due to preoperative irradiation. The incidence of perioperative complications was not increased by preoperative irradiation.