[Adjuvant radiotherapy in rectosigmoid cancers].

Radiotherapy in rectosigmoidal cancer is studied in a randomized phase-III clinical multicenter trial comparing (A) postoperative irradiation (50 Gy) to (B) preoperative irradiation + postoperative saturation (25 Gy) to (C) preoperative irradiation alone (25 Gy). Postoperative irradiation is carried out, if the patient exhibits a high risk (Dukes B, C). In preoperatively irradiated patients operation takes place immediately after the last course, at least within 24 h. Fractioning is 2,5 Gy per session. Preoperative irradiation is tolerated well. It does not compromise surgery or increase the number of complications. In rectal resections a protective colostomy is not necessary. Radical postoperative irradiation (A) is burdened by 3 serious complications and a considerably higher amount of complaints. Whereas radical radiation procedures (A and B) lead to a drastical reduction of the local recurrence rate (A 5 of 86, B 4 of 97 patients, that means about 1/7th of what could be expected), preoperative irradiation alone (C) has a lesser effect (10 of 96). Distant metastases rate remains uninfluenced by each of these procedures. Assuming that preoperative irradiation is able to inhibit intraoperative metastasing these data suggest that this form of metastases has no practical importance. Although the study is not closed there is a convincing improvement by the combined radical approach. As regards tolerability and practicability it should be done in the sandwich-technique by pre-and postoperative irradiation (B).