The main objective of this study was to evaluate the results of surgical treatment alone or associated to preoperative radiation therapy in patients with rectal adenocarcinoma. Ninety-six patients submitted to curative surgeries between 1972 and 1993 were analyzed. The main objective of the statistical analysis was to compare the five-year overall survival and local recurrence rates in patients submitted or not to preoperative radiation therapy. The five-year overall survival and the local recurrence rates for the 46 patients submitted to curative surgery alone, stage II and III, were 51.7% and 26.9%, respectively. The five-year overall survival and the local recurrence rates for the 50 patients submitted to preoperative radiation therapy (25 sessions of 180 cGy - total dose = 4,500 cGy), stage II and III, were 60.8% and 18.2%, respectively. No statistical differences in the five-year overall survival or in the local recurrence rates were observed between the two therapeutic groups. The rectal tumor stage, mainly related to pelvic metastatic lymph nodes, was the most important prognostic factor in the multivariate analysis for all therapeutic groups. Radiation in rectal cancer could be more selective: patients with mobile tumors, even infiltratives, might be submitted to immediate surgery and radiation therapy only in the high risk cases according to the pathological examination. Patients with tethered tumors could be submitted to preoperative radiation therapy due to the high risk for local recurrence.
Rectal cancer; Adenocarcinoma; Radiation therapy; Surgery