Results of a selective policy for preoperative radiotherapy in rectal cancer surgery

OBJECTIVE: Preoperative radiotherapy (pRT) for rectal cancer may reduce local recurrence and improve survival. This study was undertaken to assess a selective policy of pRT in rectal cancer. The aim was to determine whether patients likely to have involved circumferential margins (CRM) could be reliably selected for pRT using clinical criteria. We have used CRM and delay in surgery as outcome measures. PATIENTS AND METHODS: Seventy-nine patients with rectal cancer were assessed for preoperative radiotherapy using clinical criteria. RESULTS: Twelve of 26 (46%) pRT patients had positive CRM compared with three of 53 (5.6%) who did not receive pRT (P < 0.0001). Using pRT resulted in patients waiting a further 21 days before surgery (pRT 34 days vs no pRT 13 days; P < 0.0001). CONCLUSION: This policy has been effective in selecting patients most likely to benefit from radiotherapy and has avoided excessive delays prior to surgery. However, almost half of the pRT patients did not have involved CRM. With improved imaging techniques we may be able to refine our selection criteria further.