639 - Study of the effect of radical surgery combined with pre- or postoperative radiotherapy in treatment of resectable rectal cancer

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Surgical oncology
Colon and Rectal Cancer
Radiation oncology
Presenter Ehab Atif
Authors E. Atif1, H. Sakr2, S. Teama2, D. Zayed2
  • 1Surgical Gastroenterology Center, Mansoura University, Egypt, Mansoura/EG
  • 2Clinical Oncology And Nuclear Medicine, Mansoura University, Egypt, Mansoura/EG


Back ground

preoperative radiotherapy in resectable rectal cancer has a number of potential advantages, most importantly, preventing local recurrence, increasing survival and down-staging effect.


This study was done to compare between the effect of preoperative radiotherapy and postoperative radiotherapy in treatment of resectable rectal carcinoma. The primary endpoints are local recurrence rate, overall survival (OS) and disease free survival (DFS). The secondary endpoints are to evaluate down-staging, treatment toxicity, and ability to do sphincter preservation, aiming at choosing the optimal treatment modality.

Patients and methods

This study included 100 patients with resectable rectal carcinoma who presented to Surgical Gastro Entrology Center and Clinical Oncology and Nuclear Medicine Department, Mansoura University during the period between January 2007 and September 2009. The included patients were randomized in two groups; group I: 50 patients received preoperative radiotherapy and group II: 50 patients received postoperative radiotherapy. Concurrent 5-fluorouracil- based chemotherapy was given to all patients. Two major types of surgery were done: abdomino-perineal resection with a permanent colostomy and low anterior resection with colorectal or coloanal anastomosis.


Preoperative radiotherapy resulted in pathologic complete response in 3 patients. T down-staging occurred in 18 out of 50 patients (36%) with statistically significant difference (p = 0.008). N down-staging occurred in 10 out of 24 patients. Sphincter preservation was more in group I. Delayed wound healing was the most common postoperative complication in group I with no significant difference. After a median follow up of 18 months, local recurrence rate and distant metastasis were higher in group II. The 2-years disease free survival was 72% and 60% in group I and II respectively with no statistically significant difference between both groups.


This study concluded that preoperative radiotherapy is better than postoperative radiotherapy as regard local control, Sphincter preservation with higher disease free survival and overall survival. No difference in treatment toxicity between both groups.


All authors have declared no conflicts of interest.