Evaluation of Preoperative Radiation Combined with Chemotherapy for Prevention of Local Recurrence of Rectal Cancer

Hiromi Sarashina, Ikuo Inoue, Norio Saitoh, Masao Nunomura, Masayuki Yokoyama, Hajime Nakayama, Katsuji Okui, Takeshi Todoroki*, Kazuo Orii*, Yohji Iwasaki*

First Department of Surgery, School of Medicine, Chiba University
*Department of Surgery, Institute of Clinical Medicine, University of Tsukuba

A retrospective study of 44 patietns with rectal cancer who received preoperative radiation (42.6 Gy) combined with chemotherapy and 37 who received resection alone (control group) was undertaken to evaluate the effect of preoperative radiation therapy on local recurrence of rectal cancer. The rate of local recurrence in the radiation group was reduced to 4.5% compared with that in the controls (18.9%). From a pathological point of view, factors that have a close association with recurrence, such as depth of invasion, ew (defined as the distance between the external surgical surface and the deepest site of invasion) and lymph nodal involvement, have been successfully changed after radiation therapy. It was also evident that the rate of recurrence in irradiated patiens, depth of invasion of a₂ (defined as the invasion of cancer far beyond the muscle layer but without involvement of other organs) or ew less than 2 mm was significantly lower than in patients with the same pathological conditions in whom radiation was not used. However, especially in patients with remote lymph node metastasis, there was no difference in local recurrence rate between the two groups. From these findings, it was concluded that a careful follow up is necessary for patiens with remote lymph nodal involvement even after radiation therapy.

Key words
local recurrence of rectal cancer, preoperative radiation therapy, chemotherapy

Reprint requests
Hiromi Sarashina The First Department of Surgery, Chiba University School of Medicine
1-8-1 Inohana, Chiba, 280 JAPAN

Accepted
July 10, 1990

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