Definitive treatment of anal-canal carcinoma by means of radiation therapy and chemotherapy.

In the light of the relatively poor response of squamous-cell carcinoma of the anus to surgery, an alternative method of treatment has been sought. During the past five years, in a series of 19 patients, the first four were treated by a combination of preoperative irradiation, 5-fluorouracil (5-FU) and mitomycin C as radiosensitizers plus surgery. As a result of complete responses at the time of surgery of all these patients, 15 additional patients have been treated by definitive radiotherapy combined with 5-FU and mitomycin C, thereby avoiding abdominoperineal resection. Eighteen patients had local control, and the one treatment failure is discussed. The method of treatment is described, and recommendations are made concerning techniques to be used or to be avoided.

Treatment of rectal carcinomas by means of endocavitary irradiation: a progress report.

Treatment of rectal carcinomas with endocavitary irradiation is now an established method in the United States and is an important advance in the curative management of patients with selected cancers of the rectum that should be available to all such patients. Excellent palliation can also be achieved in many cases with advanced local disease. The total experience at Highland Hospital, Rochester, New York, is over 70 cases. Now that there are more centers using this method of treatment, an awareness of some of the problems and pitfalls encountered at Highland Hospital becomes relevant.

Treatment of carcinoma of the rectum and squamous carcinoma of the anus by combination chemotherapy, radiotherapy and operation.

After reviewing the recent literature, a protocol has been formulated at this hospital for patients with carcinomas of the anus and rectum larger than 5 centimeters in diameter. The protocol used in this study was a combination of chemotherapy and radiation therapy, followed four to six weeks later by abdominoperineal resection. This approach has been demonstrated clearly to be of value. All lesions decreased in size. In more than half the number of patients, the primary lesion was reduced by more than 50 per cent; 78 per cent of the patients had no nodes at operation. In ten patients, there was no tumor and, in 26, only minimal tumor. We have the impression that, if operation were delayed another two weeks, perhaps even some of these patients would have had no tumor. It is too early to be able to consider five and ten year results. However, at the same time, present results demonstrate most effectively the value of combined interdisciplinary therapy by means of the available modalities in the management of carcinoma of the rectum and anus.

Treatment of rectal carcinomas by means of endocavity irradiation.

Direct contact irradiation may be used in the curative treatment of patients with carefully selected early rectal lesions. With earlier diagnosis, a large number of patients may present with suitable lesions. The treatments last three minutes and are administered every two weeks to a total dose of 9,000 rad to 12,500 rad. The patients require no general anesthesia or hospitalization and may continue working during this treatment. There appears to be no risk of morbidity or mortality. The rectum is preserved. Most beneficial of all to the patient, a colostomy is avoided, although later surgery is not precluded for local failures. It has been found that recurrence, should it occur, appears within the 18 months immediately following treatment. Good palliation can be achieved in some cases for patients with metastatic disease, for their local symptoms. We believe that the endocavity method of irradiation contributes an important advance in the management of patients with cancer of the rectum and feel it should be available universally.

Treatment of carcinoma of the rectum by intracavitary irradiation.

Intracavitary direct contact irradiation can be used in the treatment of carefully selected patients with carcinoma of the rectum. The treatments last three minutes and are adminstered on an out-patient basis for three to five treatments with no limitation of activity. The treatments are given two weeks apart. In 25 patients, there has been no morbidity or mortality as a result of the treatments. In two patients, poorly differentiated carcinomas were not controlled, and subsequent abdominoperineal resection was required. This method of treatment should be available to more radiotherapists so the actual potential of this modality can be ascertained.

Malignant tumours of the rectum. Part I: radiotherapy.

We have confined our discussion to two modalities of treatment by means of x-ray therapy which are now being used in order to improve not only the survival rate but the quality of survival in carcinoma of the rectum. Endocavity irradiation should be established as a recognised method of therapy for selected patients with carcinoma of the rectum and it should be universally available. A number of trials are now in progress which we believe will definitely demonstrate preoperative radiation therapy as an established treatment for cancer of the rectum. It is our belief that preoperative external irradiation by means of supervoltage therapy will contribute considerably to improvement in the five-year survival figures. It may be postulated that in view of the fact that external radiation reduces the number of lymph nodes found at surgery it seems reasonable to offer patients receiving endocavity irradiation a simultaneous course of external irradiation. This may further increase the survival rate for patients with localized tumours.