The sandwich approach: irradiation-surgery-irradiation in rectal cancer. Four years' experience

A sandwich technique of adjuvant radiotherapy was used to treat 47 patients with rectal cancer. Preoperatively, 3000 rads were given for 12 days; 300 rads per day for five days, with a two-day interruption and another five days of 300 rads per day, followed by surgery ten days later. On the basis of the histopathologic findings, 26 patients with Dukes' B2 and C rectal cancer were given 3000 rads postoperatively in the same manner as the preoperative irradiation, starting four weeks after surgery. Patients with Dukes' A and B tumors received no postoperative irradiation. The preoperative radiotherapy was well tolerated by all patients with only minimal side effects. During surgery there was no technical difficulty in removing the tumor en bloc and, in some cases, the macroscopic impression was that the tumor had actually disappeared. In most cases, microscopic examination revealed fibrotic tissue replacing the tumor. In some cases, no cancer tissues were observed. The postoperative course was uneventful, the average length of hospitalization being 14.5 days. We believe that this technique of adjuvant radiotherapy with a moderate dose of irradiation is a logical and well-tolerated approach in the treatment of rectal cancer, and patients who were inoperable before irradiation became resectable after it.