Preoperative Radiotherapy in Rectal Cancer Treatment - is it Really a Golden Standard
Tr. Pătraşcu, H. Doran, O. MihalacheOriginal article, no. 2, 2014
Preoperative radiotherapy in the treatment of rectal cancer wasthought to be an achievement of similar importance to totalmesorectal excision (TME), for the therapeutic management ofrectal malignancies. However, numerous criticisms have beendiscussed in this field lately. We have analysed the two mainpurposes of preoperative radiation: possible sphincter preservationand the conversion of a non-resectable tumor into aresectable one in a series of 31 consecutive patients, operatedin our clinic. In 20 of them, preoperative radio chemoradiotherapywas applied, while 11 patients were firstly operated andthen irradiated. The surgical procedure included total mesorectalexcision in 30 patients, as part of a low anterior resection,in 13 cases and of an abdominal perineal resection, inthe other 17 cases. We have found that preoperative radiotherapyimproves the local recurrence rate but has no influenceon the overall survival rate. However, we should not overlookthe adverse effects of this method: toxicity of radiotherapy onthe small bowel and the urinary bladder, the healing of theperineal wounds and the risk of anastomotic leaks. Weconcluded in favor of elective preoperative radiotherapy inselected cases: any T4 tumors, T3 tumors which threaten themesorectal fascia on MRI, whenever there is a suspicion ofnodal involvement and also for very low tumors.
