Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma / 西安交通大学学报·英文版

ABSTRACT

Objective: To assess the effect of surgery combined with preoperative and postoperative radiotherapy ("sandwich" treatment) in rectal carcinoma. Methods: From October 1990 to January 2002, 260 patients with stage II (117 patients) and stage III (143 patients) rectal carcinoma were randomly divided into three groups "sandwich" group (92 patients, group A), postoperative radiotherapy group (98 patients, Group B) and operation group (70 patients, Group C). The preoperative accelerated hyperfractionation (15 Gy/6f/3d) was given for "sandwich" group which was followed by conventional postoperative fractionation (DT 35-40 Gy/3.5-4 weeks). Patients in Group B were given postoperative radiotherapy (DT 50 Gy/5 weeks). Patients treated with surgery alone served as control. Results: The local recurrence rates of Group A, B and C were 5.4%(5/92), 16.3%(16/98) and 64.3%(45/70), respectively (χ2 = 5.726, P = 0.017); and the distant metastasis rates were 6.5%(6/92), 28.6%(28/98) and 31.4%(22/70), respectively (χ2 = 15.703, P = 0.001). The 3-year survival rate was 86.9%(80/92), 62.2% (61/98) and 51.4%(36/70), respectively (χ2 = 15.141, P = 0.001). The 5-year survival rate was 68.5%(63/92), 54.1%(54/98) and 41.4%(29/70), respectively (χ2 = 4.218, P = 0.04). The I and II grades of radiation enterocolitis in Group A and Group B were 7.6%(7/92) and 6.1%(6/98), respectively (χ2 = 0.164, P = 0.685). Conclusion: Surgery combined with preoperative and postoperative radiotherapy can improve the survival rate and reduce the local recurrence rate in rectal carcinoma patients with stage Duke's B (II) and C (III).