Is Postoperative Radiotherapy Still Useful for the Rectal Cancer Patients in the Era of Total Mesorectal Excision?

Kim, Bong Wan; Suh, Kwang Wook; Cho, Yong Kwan; Lim, Ho Young; Chun, Mi Son; Kim, Myung Wook

Abstract

PURPOSE
The exact role of postoperative radiotherapy following curative surgery of rectal carcinoma has been debated. In this retrospective study, we examined the effect of radiotherapy on the survival and recurrence rate of rectal cancer patients who underwent total mesorectal excision (TME).
METHODS
Since June of 1994, we have recommended postoperative chemoradiation (6 cycles of 5-FU with folinic acid plus 5040 cGy external irradiation) for stage II and III rectal cancer patients. Among 134 stage II and III rectal cancer patients who underwent TME, 100 patients received postoperative chemoradiation (group A) and 34 patients decided not to receive radiation therapy (group B). For these two groups, survival and recurrence rates were compared. Follow-up times were 6 to 60 months (mean 24.7). There was no difference between two groups with regard to sex, stage of the disease, mean tumor location from dentate line, status of lateral margins, type of operation and mean follow-up duration. However, mean age was higher in group B (65.6 vs 53.9, P<0.05).
RESULTS
The overall recurrence rate showed no difference between two groups (28.0% in group A vs 21.0% in group B, P>0.05). Local recurrence rate was also similar (11.0% vs 3.0%). There was no significant difference in duration between surgery and initial recurrence (14.0 months vs 11.0 months, P=0.18). The 5-year-disease-free survival rate was 57.0% in group A and 63.0% in group B (P=0.33).
CONCLUSION
In this study, we found no beneficial effect of postoperative radiation therapy following TME for the rectal cancer.