Preoperative irradiation with high-dose fractionation in adenocarcinoma of the rectum and rectosigmoid.

The incidence of local pelvic recurrence after 'curative' resection for rectal carcinoma is high. Adjuvant irradiation given pre- or postoperatively has led to a decreased incidence of pelvic recurrences. In a series of 58 consecutive patients between 1979 and 1980, those with primarily operable rectal tumours received preoperative irradiation in a total dose of 25.5 Gy in fractions of 5.1 Gy daily for 5 days. A locally 'curative' resection was performed in 41 patients 2 to 5 days later. The radiation therapy was well tolerated without early or late complications. All patients were followed up every 6 months with computed tomography over the pelvic region; aspiration biopsies were taken whenever any possible pathology was made. A local recurrence occurred in only 2 patients during the follow-up period (24-42 months). In a retrospective material from 1976 to 1979, totally 107 patients were admitted for surgery. Of 81 patients operated upon for 'local cure', 38 (47%) have had local recurrence to date, 32 (40%) of them within 2 years. These results indicate that a high-dose fractionated preoperative irradiation reduces the incidence of local recurrences, is well tolerated and does not influence the period of hospitalization.

RCT Entities:   Population Interventions Outcomes