PREOPERATIVE OR POSTOPERATIVE RADIOTHERAPY IN RECTAL-CARCINOMA - A RANDOMIZED MULTICENTER TRIAL

Between October 1980 and December 1985, 471 patients with a resectable rectal carcinoma entered a randomized multicenter trial for comparison of pre- and post-operative irradiation. Two hundred and thirty-six patients were allocated to receive high-dose fractionated preoperative irradiation (total dose 25.5 Gy in 5-7 days) and 235 patients to receive postoperative irradiation to a very high dose level with conventional fractionation (60 Gy in totally 8 weeks). The post-operative treatment was delivered only to a high-risk group of patients (Astler-Coller stages B2, C1 and C2). The preoperative irradiation was well tolerated, with no immediate irradiation-related complications and no increased postoperative mortality (3 %, 7/217, compared to 5 %, 10/215 in the postoperative group). More patients in the preoperative irradiation group had perineal wound sepsis after abdominoperineal resection and this prolonged the stay in hospital after surgery. In 50 % of the patients the postoperative treatment could not be commenced until more than six weeks after surgery. The postoperative treatment was not as well tolerated as the preoperative one. The local recurrence rate was statistically significantly lower after preoperative than after postoperative radiotherapy (12 % versus 21 %; p = 0.02). In both groups more patients developed a local recurrence if the bowel was perforated at surgery or if the resection line was microscopically close to the tumour. To date, with a minimum follow-up of 3 years and a mean follow-up of 6 years, there is no difference in survival between the two groups.