Preoperative radiotherapy and IORT in resectable rectal cancer at high risk for local recurrence

Over a 4-year period 35 patients with mid- (15 patients) and low (20 patients) rectal cancer clinically staged as T2 N1-2, T3 N0-2 underwent a protocol of combined surgery and radiotherapy. The protocol included: preoperative external beam radiotherapy (38 Gy, ICRU50); surgical resection; IORT on tumor bed (10 Gy). Toxicity of preoperative treatment was mild with a single case (2.9%) of grade 3 gastrointestinal toxicity. 18 patients underwent anterior resection and 17 abdominoperineal resection. Perioperative mortality and morbidity were 0% and 17.1% respectively. At a mean follow-up of 25 months all patients were alive. The single anastomotic recurrence observed was rescued with abdominoperineal resection.