Combined modality preoperative therapy in poor prognostic rectal adenocarcinoma.

Between 1976 and 1986, 64 patients with rectal adenocarcinoma who were considered unresectable or had prognostic signs suggestive of high risk for local failure received preoperative adjuvant therapy. They were treated with pelvic irradiation (40 Gy) combined with 5-fluorouracil (5-FU) and mitomycin-C, followed by surgery. All had definitive resections resulting in 12.5% of operative specimens free of tumor and only 26.5% containing nodal metastases. The projected 5-year disease-free survival rate is 64% with an actuarial survival of 68%. No mortality or severe morbidity has been observed. Combined modality therapy is a safe and effective regimen for those rectal tumors in the high risk category.