Postoperative adjuvant radiotherapy for XXXX and rectosigmoid.

@entity1 @entity1744 @entity5 @entity188
One hundred five @entity1 treated with potentially curative surgery and adjuvant postoperative radiotherapy for @entity188 and rectosigmoid from 1973 through 1981 were reviewed. Radiation therapy was given with 18-25 MeV X rays in doses of 40-50 Gy in 5 weeks (midline dose) using AP-PA fields in 97 @entity1 . A boost of 6 to 10 Gy was directed to the area of maximum risk by anterior-posterior or perineal fields in 71 @entity1 . Local failure occurred in 15 @entity1 and was documented pathologically in 8 @entity1 , or clinically or radiologically in 7 @entity1 . The local recurrences according to the Modified Astler-Coller staging criteria were: B1: 0% (0/3); B2: 4% (1/24); B3: 31% (4/13); C1: 8% (1/12); C2: 18% (8/45); C3: 20% (1/5). Local failure after adjuvant radiotherapy versus surgery alone was compared. The comparison of local failure of combined treatment versus surgery alone, from our institution, is as follows: B2-4% vs 13%, B3-31% vs 26%, C2-18% vs 30%, and C3-20% vs 49%. Sixty-one @entity1 (58.1%) have been followed for 5 years, with a median of 73 months and a minimum of 24 months. The actuarial 5-year survival (disease-free) for the entire group is 55% and is not statistically different for the groups with negative or positive nodes. Fourteen @entity1 (13%) required surgery for small bowel complications; four others (4%) had symptomatic @entity1744 treated with conservative therapy only. @entity1744 occurred in 4 of 16 (25%) treated with radiation fields above L5, whereas those treated below L5 had an 11% incidence. Postoperative adjuvant radiotherapy can increase local @entity5 control compared to surgery alone. The small bowel complication rate in this series most likely reflects AP-PA treatment technique and can be decreased by the use of multiple fields with maximum shielding of the small intestine.
