gms | German Medical Science

Aim: To review initial institutional experience with the use of TEM and RCT in early rectal cancer.

Method: 11 patients with preoperative RCT and 16 patients with postoperative RCT for stage I adenocarcinoma of the rectum were treated with TEM between May 1998 and August 2003. Radiotherapy (RT) was planned as conformal treatment in 3- or 4-field-techniques with 5 x 1.8 Gy per week to total doses of 45-50.4 Gy to the tumor and locoregional lymph nodes, and a subsequent boost of 5.4 to 9.0 Gy, in tumors carrying risk factors (T2 and/or G3 and/or lymphangiosis). Chemotherapy (CHT) was 5-FU based, with a planed short infusion (90 minutes) at a dose of 500 mg/sqm for 5 days in week 1 and 5 of RT. Surgery was performed as TEM of the total rectal wall with immediately reconstruction of the rectal passage. Follow-up investigations were 3-monthly during the first year, thereafter in 6-months intervals, with rectoscopy, abdominal ultrasound, and CEA. Mean follow-up for surviving patients is 23 (0-56) months.

Results: Local recurrence was observed in 6 (24 %) and distant metastasis in 8 (31 %) patients. Risk factors for tumor recurrence were grade 3 tumors, lymphangiosis, and prolonged interval between RCT and resection. Four patients died due to cancer. Acute high-grade (> 3) toxicity was rare, with pancytopenia grade IV and subsequent sepsis, and with grade 3 of diarrhea, oral mucositis, nycturia and polakisuria, and epididimitis in one (4%) patient each.

Conclusion: TEM combined with RCT appeared effective and low-toxic in patients with pT1-pT3 tumors. Nevertheless, a local recurrence rate of 24 % percent calls for further studies with optimization of both surgical and radiochemotherapeutic procedures in tumors carrying additional risk factors such as lymphangiosis or poor differentiation.