Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid

Local recurrence occurs in 30% to 50% of rectal cancer patients treated with surgery alone if there is tumor extension beyond the bowel wall alone or in conjunction with nodal involvement. This analysis is of 97 such patients who received postoperative irradiation (XRT) in prospective and standardized fashion at Massachusetts General Hospital (MGH) (4500 rad in 25 fractions to large fields and minimum dose of 5040 rad in 28 fractions within a boost field). Results were compared with a group of 103 previously analyzed patients treated with surgery alone at MGH. A statistically significant decrease in local recurrence was seen in four of the six irradiated subgroups (modified Astler-Coller Stages B2g, B3, C1 + C2m, and C2g) at an interval 3 years from resection. This improvement was achieved with no increase in small bowel complications (4% with XRT versus 5% with surgery alone) in view of efforts at surgical reconstruction and use of multiple-field XRT techniques, bladder distension, etc.