Preoperative radiation therapy for clinically resectable XXXX .

@entity1 @entity75 @entity5 @entity260 @entity188 @entity3
This is an analysis of 71 @entity1 with clinically resectable @entity188 treated with preoperative irradiation and surgery at the University of Florida from July 1975 through December 1981. Seven @entity1 were found to have liver @entity3 at surgery; six had a complete resection of their primary @entity75 and one had an incomplete resection of the @entity5 . The remaining 64 @entity1 had no evidence of @entity3 at the time of surgery and underwent a complete resection of their @entity5 . In the early years of the trial, the maximum @entity5 dose consisted of 3000 to 3500 rad in 3.5 to 4 weeks; the dose was subsequently increased to 4500 rad in 5 weeks. @entity1 were taken to surgery between 2 and 11 weeks (mean, 3.5 weeks) following the completion of radiation therapy. All @entity1 have a minimum follow-up of 3 years and 63% have a minimum follow-up of 5 years. The acute complications of treatment have been acceptable, with only one @entity1 requiring a treatment rest for moist desquamation of the perineum. All @entity1 completed the irradiation course and all were operated on. Pathologic examination of the surgical specimen revealed no @entity5 in 11%, and the incidence of positive lymph nodes was 19%, which was half the incidence of positive lymph nodes in a series of historical controls treated from 1959 to 1976 with surgery alone. Comparison of @entity1 treated with preoperative irradiation and surgery with those treated with surgery alone revealed that the @entity260 have been similar in incidence, distribution, and severity. There have been no postoperative deaths. The overall incidence of local-regional recurrence is 5/64 (7.8%), and the combined incidence of local-regional recurrence and/or distant @entity3 is 18/64 (28%). The incidence of local-regional recurrence by preoperative dose is 3/23 (13%) for doses of 3000 to 3500 rad and 2/41 (5%) for doses of 4000 to 5000 rad. The 5-year local-regional failure rate is 3/40 (7.5%) for the group irradiated before surgery, and 39/135 (29%) for the historical controls managed by surgery alone (significance level = 0.015). The 5-year determinate disease-free survival is 27/38 (71%) for the @entity1 irradiated before surgery, and 47/114 (41%) for the historical group of @entity1 treated with surgery alone (significance level = 0.008).
