Ten years' experience with a multimodality treatment of advanced stages of rectal cancer

Patients with inoperable rectal cancer have a remote chance of 5-year survival. In an attempt to improve this poor prognosis a combined radiochemotherapeutic regimen in a split form followed by long term chemotherapy maintenance was used in their management. From January 1971 until December 1980, three categories of patients were so treated. 100 Patients with an inoperable rectal primary (IP) or locally recurrent after anterior resection (LR) with no evidence of distant metastases; 71 patients with pelviperineal recurrences after rectal amputation (PPR); and 28 patients with primary rectal cancer and asymptomatic liver metastases (PALM). Side effects were tolerable and could be medically controlled. The local response rates in the three groups, respectively, were 79%, 85% and 85%. The median duration of this response lasted 25, 16 and 14 months, respectively, after which there was local progression of disease. The median survival rates were 19, 19 and 13 months, respectively. None of the PALM group lived for more than 30 months, while there were 20% 5-year survivors in the IP-LR group and 15% in the PPR group. The incidence of distant metastases in these last two groups were 20% and 50% at 5 years, respectively, while incidence of late complications was about 10%. This regime offers a good palliative measure with a possible 15% to 20% chance of long-term disease-free survival.