Carcinoma of the rectum: 508 patients with failure analysis and implication for adjuvant therapy.

Five hundred and eight patients with carcinoma of the rectum, seen between 1970 and 1980, were reviewed. The numbers of patients in each of the Astler-Coller stages were: stage A: 86; B1: B2: 145; C1: 19; C2: 116; and D (those with metastatic disease): 78. Resection was possible in 92.4% of the patients and operative mortality was 2.3%. Excluding stage D patients, the 5- and 10-year actuarial survivals were 56.9% and 43.7% respectively. When adjusted for deaths from intercurrent disease the 5- and 10-year survivals were 66.8% and 56.3%. Frequency of local recurrence by stage at five years was as follows: stage A: 5.8%; B1: 14%; B2: 20%; C1: 31.5%; and C2: 33.6%. An isolated local recurrence was seen in 5.8% of stage A patients, 12.5% of B1, 13.1% of B2, 15.8% of C1 and 2.6% of C2 staged patients. Histological grade was an important prognostic factor independent of stage. Distance of the tumor above the anus and presence of venous invasion1 could not be assessed. Among stage C patients, survival was 57% when there was one node involved, but this figure fell to approximately 30% with involvement of two or more nodes. Analysis of failure rates suggests that adjuvant radiation treatment is of potential benefit in patients with stages B2, C1, or C2 disease and in stage B1 patients with additional risk factors. The data indicate that adjuvant local treatment is unlikely to increase survival in stage C2 patients, since almost all recurrences in this stage are accompanied by distant metastases.