Adjuvant radiotherapy with selective sandwich technique in treatment of rectal cancer: results of a continuing study.

Sixty-two patients with carcinoma of the rectum were treated with "selective sandwich" adjuvant radiotherapy in a pilot study which began in September 1976 at Thomas Jefferson University Hospital. All patients received 500 rads preoperative irradiation on the day of or day preceding surgery. Following surgery, the lesions were staged pathologically according to Astler-Coller's modification of Dukes' staging. Patients with poor prognostic characteristics (Stages B2, C1, and C2) were treated with aggressive postoperative pelvic irradiation (4500 rads in five weeks). All 62 patients received the single preoperative dose of 500 rads. Forty-four patients underwent abdominoperineal resection, four patients, a low anterior resection, ten patients, a combined abdominotranssacral resection, and four patients found to have liver metastasis at laparotomy had colostomy followed by palliative therapy. Twenty-one patients found to have early disease (Stages A or B1) were given no further therapy. Of 37 patients with Stages B2 or C disease, 21 received postoperative irradiation. Follow-up ranged from 6 months to 36 months, with a median of 18 months. Of patients with Stage A or B1 disease, one patient has died with metastasis. Two of 21 patients receiving postoperative irradiation have developed metastatic disease; neither has failed in the pelvis. Of 16 patients who did not receive postoperative irradiation, three have had metastasis to the pelvis and two others have developed distant metastasis.