MIAMI BEACH--Sphincter-preserving surgical techniques can be safely
and effectively combined with high-dose preoperative radiation
for tumors in the most distal segments of the rectum, Mohammed
Mohiuddin, MD, said at the American Society for Therapeutic Radiology
and Oncology (ASTRO) meeting.
Dr. Mohiuddin, professor and chairman, Department of Radiation
Medicine, University of Kentucky, Lexington, reported that this
approach resulted in excellent local control, improved survival,
and enhanced quality of life, with retention of normal anal sphincter
function in the majority of patients.
His conclusions are based on results in 70 patients with tumors
in the distal 2 cm of the rectum who were part of a series of
259 rectal cancer patients enrolled in a program of high-dose
preop-erative radiation and sphincter-preserving surgery. All
surgeries were performed by Gerald Marks, MD, who is now professor
of surgery, Medical College of Pennsylvania-Hahnemann University.
"The availability of anastomic stapling devices and the introduction
of new surgical techniques have expanded the options for sphincter-preservation
surgery to more distal segments of the rectum, providing an alternative
to abdominal perineal resection and loss of anal function,"
Dr. Mohiuddin said.
However, he added, current approaches for surgical resection of
rectal cancer still call for a 2 cm distal margin to prevent excessive
local disease recurrence. "Sphincter-preservation surgery
has thus been limited to tumors at least 2 cm proximal to the
anal-rectal junction," he said.
In the current series, all patients received a minimum dose of
40 to 45 Gy over 4½ weeks at 1.8 to 2.5 Gy per fraction.
Patients with unfavorable tumors were given an additional boost
of 10 to 15 Gy. Surgery was performed 4 to 10 weeks after the
completion of radiation therapy. Median follow-up was 4 years.
Overall, there was one perioperative mortality. Two patients did
not have their colostomy closed because of complications. Four
patients required late colostomies because of local recurrence.
Sixty patients (86%) maintained satisfactory long-term sphincter