Postoperative chemoradiotherapy in rectal cancer. Long-term results of a pilot study.

It has recently been proven that postoperative radiotherapy combined with fluorouracil affords an increase in survival and local control in patients with rectal cancer. However, haematological and intestinal toxicity also increase. Experimental and clinical studies have shown an increased effect of radiation with an acceptable toxicity by delivering the drug via continuous intravenous infusion. From 1988 to 1998, 80 patients radically operated on for stage B2-C rectal cancer were irradiated with 3 fractions of 100 cGy per day up to a total dose of 5,600 cGy; 34 of these patients underwent postoperative radiotherapy alone and 46 received radiotherapy combined with concomitant protracted infusion of fluorouracil at doses of 250 mg/m2 per day. After a median follow-up of 60 months, the 5-year overall and disease-free survival rates were 59% and 54%, respectively, in the combined modality group, as compared to 42% and 34%, respectively, in the radiation alone group. The differences were non-significant, but the incidence of local relapse and patient survival showed better trends with the combined approach. The international literature data are in favour of a combined approach in both the preoperative and postoperative treatment of advanced rectal cancer. Adjuvant therapy needs to be re-assessed in trials using total mesorectal excision as the standard operative technique.