ABSTRACT
We report a case of Stage IE mucosa-associated lymphoid tissue lymphoma arising in the rectum, which was successfully treated with radiotherapy. A 60-year-old man had several months of altered bowel habit with rectal bleeding and was found to have a large rectal tumor with no evidence of distant spread. Histologic studies showed this to be a mucosa-associated lymphoid tissue lymphoma. The patient received 45 Gy in 25 fractions with external beam radiotherapy during 5 weeks. The treatment was well tolerated and review at 41 months revealed no evidence of recurrence.
Subject(s)
Lymphoma/radiotherapy , Rectal Neoplasms/radiotherapy , Dose Fractionation, Radiation , Humans , Intestinal Mucosa , Lymphoma/pathology , Male , Middle Aged , Rectal Neoplasms/pathologyABSTRACT
PURPOSE: A worsened anorectal function after chemoradiation for high-risk rectal cancer is often attributed to radiation damage of the anorectum and pelvic floor. Its impact on pudendal nerve function is unclear. This prospective study evaluated the short-term effect of preoperative combined chemoradiation on anorectal physiologic and pudendal nerve function. METHODS: Sixty-six patients (39 men, 27 women) with localized resectable (T3, T4, or N1) rectal cancer were included in the study. All patients received 45 Gy (1.8 Gy/day in 25 fractions) over five weeks, plus 5-fluorouracil (350 mg/m2/day) and leucovorin (20 mg/m2/day) concurrently on days 1 to 5 and 29 to 33. Patients who had rectal cancer with a distal margin within 6 cm of the anal verge had the anus included in the field of radiotherapy (Group A, n = 26). Patients who had rectal cancer with a distal margin 6 to 12 cm from the anal verge had shielding of the anus during radiotherapy (Group B, n = 40). The Wexner continence score, anorectal manometry and pudendal nerve terminal motor latency were assessed at baseline and four weeks after completion of chemoradiation. RESULTS: The median Wexner score deteriorated significantly (P < 0.0001) from 0 to 2.5 for both Groups A (range, 0-8) and B (range, 0-14). The maximum resting anal pressures were unchanged after chemoradiation. The maximum squeeze anal pressures were reduced (mean = 166.5-157.5 mmHg) after chemoradiation. This change was similar in both Groups A and B. Eighteen patients (Group A = 7, Group B = 11) developed prolonged pudendal nerve terminal motor latency after chemoradiation. These 18 patients similarly had a worsened median Wexner continence score (range, 0-3) and maximum squeeze anal pressures (mean = 165.5-144 mmHg). The results obtained were independent of tumor response to chemoradiation. CONCLUSIONS: Preoperative chemoradiation for rectal cancer carries a significant risk of pudendal neuropathy, which might contribute to the incidence of fecal incontinence after restorative proctectomy for rectal cancer.
Subject(s)
Adenocarcinoma/therapy , Fluorouracil/therapeutic use , Leucovorin/therapeutic use , Motor Neurons , Peripheral Nervous System Diseases/etiology , Rectal Neoplasms/therapy , Rectum/innervation , Adenocarcinoma/drug therapy , Adenocarcinoma/pathology , Adenocarcinoma/radiotherapy , Adenocarcinoma/surgery , Adult , Aged , Antimetabolites, Antineoplastic/adverse effects , Antimetabolites, Antineoplastic/therapeutic use , Biopsy , Female , Fluorouracil/adverse effects , Follow-Up Studies , Humans , Leucovorin/adverse effects , Male , Manometry , Middle Aged , Motor Neurons/drug effects , Motor Neurons/radiation effects , Peripheral Nervous System Diseases/physiopathology , Preoperative Care , Pressure , Prospective Studies , Radiotherapy, Adjuvant/adverse effects , Rectal Neoplasms/drug therapy , Rectal Neoplasms/pathology , Rectal Neoplasms/radiotherapy , Rectal Neoplasms/surgery , Rectum/physiopathology , Risk Factors , Vitamin B Complex/adverse effects , Vitamin B Complex/therapeutic useABSTRACT
Giant condyloma acuminatum (GCA) is a tumour that primarily affects the genital and perianal areas. Despite the histologically benign appearance, it behaves in a malignant fashion, destroying adjacent tissues, and is regarded as an entity intermediate between an ordinary condyloma acuminatum and squamous cell carcinoma. Primary anorectal lesions account for only a small number of GCA cases and, as with squamous cell carcinoma, the human papilloma virus is the causative agent. The hallmark of GCA is the high rate of local recurrence and transformation into squamous cell carcinoma. We describe a case of GCA complicated by malignant transformation, where locoregional control was achieved with combined chemoradiotherapy.
Subject(s)
Anus Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Cell Transformation, Neoplastic/pathology , Condylomata Acuminata/pathology , Anus Neoplasms/therapy , Carcinoma, Squamous Cell/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Condylomata Acuminata/therapy , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Staging , Radiotherapy, Adjuvant , Risk Assessment , Treatment OutcomeABSTRACT
Over the last three decades, a series of clinical trials have led to the use of adjuvant pelvic radiotherapy and chemotherapy in high-risk (T3-4 or N1) rectal cancer. There is a need to improve patient selection in order to identify the group most at risk for recurrent disease. The toxicity of adjuvant therapy should be factored into this consideration. The optimal sequencing of adjuvant therapy before or after surgery, the use of short- or long-course radiotherapy, and the utility of concurrent chemotherapy is currently being examined in randomized controlled trials (RCTs). The aim of this report was to review the morbidity and mortality in all RCTs of adjuvant therapy for rectal cancer.