Preoperative irradiation for unresectable carcinoma of the rectum.

The records of 20 patients with unresectable carcinoma of the rectum who received preoperative radiation therapy (4,300 to 5,580 cGy) in an attempt to facilitate resection were reviewed. Patients were stratified as unequivocally unresectable at the time of diagnosis or borderline resectable. Thirteen of the 20 patients were able to undergo resection with curative intent after radiotherapy. Patients had follow-up examinations for a minimum of five years, and median survival period for all patients was 43 months with a five year survival rate of 40 percent. Patients stratified to unequivocally resectable survived for a median of only 17 months. Three of the 13 patients who underwent a curative resection had a local recurrence in the pelvic area. Sixteen complications occurred in nine of the 17 patients who underwent any sort of resection, with infectious and wound healing complications being most prevalent. The incidence of complications in similar series is discussed and the need for better selection of patients is addressed.