Evaluation of the benefit with adjuvant post-operative radiotherapy for rectal carcinoma

ABSTRACT

The study included 85 cases of cancer rectum. Their ages ranged from 15 to 75 years with mean age of 45 years, higher incidences were present in 3rd and 5th decades of life. Male to female ratio was 1.7 1. The main presenting symptoms were Bleeding per rectum in 40% of cases, tenesmus in 28% of cases and changes of bowel habits in 15% of cases, but more than one symptom were present in the majority of cases. The lesions were lower 1/3 in 60 patients [70.59%] a middle 1/3 in 15 cases [17.65%] and upper 1/3 in 10 cases [11.76%]. The commonest pathological type was adenocarcinoma with variable grade of differentiation [60 cases]. Abdominoperineal resection was done in 65 patients [70.47%] and anterior resection was done in 20 cases [23.53%]. Cases randomly assigned to either surgical resection with adjuvant postoperative external radiotherapy to a dose of 5000 Gy/5 w/25 ttt, 46 cases [45.12%], or surgical resection alone 39 cases [45.88%]. The follow up period was between 6 months to 2 years in both groups. Local recurrence occurred in 21 cases [24.71%], distant metastases in 12 cases [14.12%], concomitant local recurrence and distant metastases in 8 cases [9.41%]. Survival disease free period was reported in 44 cases [52%] with higher incidence in case treated by postoperative radiotherapy but the difference was statistically nonsignificant. So, postoperative radiation therapy alone can not be justified as a routine in management of resectable rectal carcinoma, but could be used as an adjuvant to surgical resection with little benefit due to late presentation of cases