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December 1991

High-Dose Preoperative Radiation and Radical Sphincter-Preserving Surgery for Rectal Cancer

Author Affiliations

From the Department of Surgery, Division of Colorectal Surgery, The Comprehensive Rectal Cancer Center (Drs Marks and Rakinic) and the Department of Radiation Oncology and Nuclear Medicine (Dr Mohiuddin), Thomas Jefferson University Hospital, Philadelphia, Pa; Rambam University Hospital, Haifa, Israel (Dr Eitan); and La Sapienza University, Rome, Italy (Dr Masoni).

Arch Surg. 1991;126(12):1534-1540. doi:10.1001/archsurg.1991.01410360108018

• To reduce local recurrence associated with rectal cancer and to extend the scope of anal sphincter preservation, a selective program of high-dose preoperative radiation therapy and sphincter-preserving surgery was initiated in 1976. High-energy photon therapy (40 to 60 Gy) was administered in doses of 1.8 to 2.5 Gy during a period of 4½ to 6 weeks and followed in 4 to 6 weeks with curative sphincter-preserving surgery for clinicopathologically unfavorable and low rectal cancers. None of the 143 patients in the study died during the postoperative period. Fifteen (13%) of 117 patients followed up for at least 24 months experienced local recurrence. Acceptable sphincter function was retained in 130 patients (91%). Our program of high-dose preoperative radiation therapy and sphincter-preserving surgery for the treatment of high-risk cancers, including those in the distal third of the rectum, resulted in better-than-expected survival and control of local recurrence with acceptable morbidity and no mortality.

(Arch Surg. 1991;126:1534-1540)