Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: Long term follow-up Journal Article


Authors: Wagman, R.; Minsky, B. D.; Cohen, A. M.; Guillem, J. G.; Paty, P. P.
Article Title: Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: Long term follow-up
Abstract: Background: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods: Thirty six patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (5,T2; 31,T3) involving the distal half of the rectum and clinically required an abdominoperineal resection. The median tumor size was 3.8 cm [range: 1.5-7 cm] and the median distance from the anal verge was 4 cm [range: 3-7 cm]. The whole pelvis received 46.80 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 56 months [range: 4- 121 months]. Results: Of the 35 patients who underwent resection, 5 (14%) had a complete pathologic response and 27 (77%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 5-year actuarial: 21%. The 5-year actuarial survival was 64%. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in the 27 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 85%. The median number of bowel movements/day was 2 (range: 0-8). Conclusions: Our data suggest that preoperative radiation therapy allows sphincter preservation in 77% of selected patients who would otherwise require an abdominoperineal resection, and 85% have good to excellent sphincter function. Given the moderate local failure rate, we now routinely use preoperative combined modality therapy plus postoperative chemotherapy for patients with clinical T3 disease.
Keywords: cancer survival; clinical article; human tissue; treatment failure; human cell; clinical trial; fatigue; fluorouracil; diarrhea; adjuvant therapy; preoperative care; combined modality therapy; follow up; neoplasm staging; adenocarcinoma; phase 2 clinical trial; nausea; vomiting; radiotherapy dosage; preoperative period; erythema; organ preservation; phase 1 clinical trial; rectal neoplasms; rectum cancer; colon; anastomosis, surgical; rectal cancer; anal canal; rectum abdominoperineal resection; anus sphincter; humans; human; male; female; priority journal; article
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 42
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 1998-08-01
Start Page: 51
End Page: 57
Language: English
DOI: 10.1016/s0360-3016(98)00180-1
PUBMED: 9747819
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Philip B Paty
    359 Paty
  2. Bruce Minsky
    256 Minsky
  3. Jose Guillem
    361 Guillem
  4. Alfred M Cohen
    162 Cohen