Résumé
The authors report their experience of 307 patients with rectal cancer treated with pre-operative radiation treatment: 6 x 2.1 Grays/week during 3 consecutive weeks followed 3 to 8 days later by surgery: abdominoperineal resection in 45 %, trans-anal local excision in 7 % and anterior resection in 48 % of the patients. Post-operative mortality and morbidity are not significantly different from those observed in patients, treated by surgery alone. Local results are improved in pre-operatively irradiated patients as compared to the purely surgical series: understaging: negative operative specimens in 7 % of the patients, Dukes A: 10 %, Dukes B: 60 %; Dukes C: 23 %; positive nodes in 23 % of the patients whereas 40 % of the patients treated with surgery alone have usually positive nodes ; reduction of local recurrence rates: 9.5 % (isolated local recurrences in 6.1 % and local recurrences combined with distant metastases in 3.4 % of the patients). The 5 year survival all stages combined is 75 %. The significant prognosis criteria are: the tumour volume (p < 0.005), the parietal infiltration (p = 0.001), the node involvement (p = 0.0001), and the histological type (p < 0.05). The questionable conversion of non conservative treatments in sphincter-saving treatments, the real place of pre-operative radiation therapy in rectal carcinoma are discussed in the context of published data.