High-dose preoperative radiation and radical sphincter-preserving surgery for rectal cancer.

To reduce local recurrence associated with rectal cancer and to extend the scope of anal sphincter preservation, a selective program of high-dose preoperative radiation therapy and sphincter-preserving surgery was initiated in 1976. High-energy photon therapy (40 to 60 Gy) was administered in doses of 1.8 to 2.5 Gy during a period of 4 1/2 to 6 weeks and followed in 4 to 6 weeks with curative sphincter-preserving surgery for clinicopathologically unfavorable and low rectal cancers. None of the 143 patients in the study died during the postoperative period. Fifteen (13%) of 117 patients followed up for at least 24 months experienced local recurrence. Acceptable sphincter function was retained in 130 patients (91%). Our program of high-dose preoperative radiation therapy and sphincter-preserving surgery for the treatment of high-risk cancers, including those in the distal third of the rectum, resulted in better-than-expected survival and control of local recurrence with acceptable morbidity and no mortality.