Radio-chemioterapia preoperatoria nel trattamento del carcinoma del retto localmente avanzato

Rectal cancer is characterised by a substantial incidence of recurrences despite radical surgical treatment. The combination of preoperative radio- and chemotherapy has afforded functional and prognostic advantages through the prospect it offers of performing a greater number of conservative operations and the enhanced control of locoregional recurrences it allows. In our institute we treated 27 patients with locally advanced rectal cancer over the period from January 1997 to December 2002. All 27 patients underwent preoperative radiochemotherapy (45 Gy on the pelvis and 5-fluorouracil administered on the first and last 5 days of radiotherapy). The patients were then submitted to surgery consisting in 12 abdomino-perineal resections of the rectum, 14 anterior rectal resections and 1 Hartmann's resection. Tumour regression was complete in 22.22% of cases and minimal in 14.81%; 50% reduction was achieved in 22.22% and 50-80% reduction in 40-70% of cases. The toxicity was 14.91%. The incidence of local failure was 3.7% with a follow-up of 52 months. In this series, preoperative radio-chemotherapy proved to be a powerful means of downstaging the tumours and of controlling local failure.