Predicting local recurrence of carcinoma of the rectum after preoperative radiotherapy and surgery

Author:

Jones D J12,Zaloudik J2,James R D3,Haboubi N4,Moore M2,Schofield P F1

Affiliation:

1. Department of Surgery, Christie Hospital and Holt Radium Institute, Wilmslow Road, Manchester M20 9BX, UK

2. Paterson Institute for Cancer Research, Christie Hospital and Holt Radium Institute, Wilmslow Road, Manchester M20 9BX, UK

3. Department of Radiotherapy, Christie Hospital and Holt Radium Institute, Wilmslow Road, Manchester M20 9BX, UK

4. Department of Histopathology, Withington Hospital, Manchester M20 8LR, UK

Abstract

Abstract A prospective study of prognostic factors has been carried out in a group of 186 patients with tethered rectal carcinomas. Of these, 97 were randomized to surgery alone and 89 to receive preoperative radiotherapy (20 Gy in four fractions). DNA ploidy was determined by flow cytometry. DNA aneuploidy was detected in 60 patients (62 per cent) in the surgery only group, but in only 33 patients (37 per cent) after radiotherapy (P0·01). There was a significant reduction in local recurrence in irradiated patients (P<0·0001). DNA diploid tumours were less likely to recur locally: This was more marked in the radiotherapy group (P = 0·01) than in the surgery only group (P = 0·06). After radiotherapy, only the surgeons' assessments of a ‘curative’ resection and DNA ploidy were independent predictors of local recurrence in multivariate regression analysis, whilst Dukes' classification was not. In conclusion, DNA ploidy may indicate response to radiotherapy and is an important predictor of subsequent local tumour progression.

Funder

North West Regional Health Authority

Cancer Research Campaign

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference13 articles.

1. Recurrence and survival after total mesorectal excision for rectal cancer;Heald;Lancet,1986

2. Intracavity irradiation of early rectal cancer for cure;Papillon;Cancer,1975

3. External beam radiotherapy for rectal adenocarcinoma;Taylor;Br J Surg,1987

4. Resection of inoperable rectal cancer following radiotherapy;James;Br J Surg,1985

5. Adjuvant radiotherapy in rectal cancer: the MRC trials;Duncan;Br J Surg,1985

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