Rectal carcinoma. Long-term experience with moderately high-dose preoperative radiation and low anterior resection.

This report updated an analysis of a 14-year experience of moderately high-dose (4500 to 5000 cGy) preoperative radiation as an adjuvant to low anterior resection of 95 cases of adenocarcinoma of the rectum. The treatment was well tolerated without treatment-related mortality and with a low incidence (5.2%) of severe complications. The local recurrence rate was 4.2%, and distant failure rate was 10.5%. At 5 years, the actuarial survival rate was 66% and the disease-free survival rate was 64%. At 10 years, the actuarial survival rate and disease-free survival rate were 52%. The authors concluded that moderately high-dose (4500 to 5000 cGy) neoadjuvant radiation in clinically resectable adenocarcinoma of the rectum in which one segment of the anastomosis was in the preoperative radiation field is a safe, effective adjuvant to low anterior resection and that it offered patients excellent local control, long-term survival, and sphincter preservation. Results could be enhanced by chemotherapy, and the authors urged well-designed prospective randomized multicenter trials to determine the most appropriate drugs, dosage, and sequencing of co-adjuvant preoperative radiation therapy and chemotherapy with surgery.

Whole abdominal irradiation in non-Hodgkin's lymphomas. I. Tolerance and outcome.

Thirty patients, over a 16-year period, treated with whole abdominal irradiation for non-Hodgkin's lymphoma were reviewed. Therapy tolerance, acute toxicity, and long-term outcome were determined. When adequate protection of vital intraabdominal organs was instituted properly, patient tolerance required only conservative medical management. Peripheral hematologic values exhibited mild depressions to nadir values near completion (3,500-4,000 rad) of treatment. Blood count recovery and general functional normalization occurred within the first post-treatment month. Average total weight loss was only 3.5 pounds with a similar pattern of recovery following therapy completion. Sixteen patients with average follow-up of 6 years still survive. Comparative studies involving total abdominal irradiation for human malignancies are also discussed.

Whole abdominal irradiation in non-Hodgkin's lymphomas. II. Therapeutic criteria.

Three hundred ninety-one patients treated for non-Hodgkin's lymphoma from 1966 until 1983 were reviewed to discover a subset of 29 patients for whom whole abdominal radiation was the common modality of treatment. Seventeen patients were studied with staging laparotomy. the remainder by biopsy. Histologic characteristics revealed a diffuse-type pathology in 15 patients and a nodular-type in 14. Patients were further subselected into "favorable" (DWDLL, NPDLL, NML) and "unfavorable" (DULL, DML, DHL, DPDLL) histologies. Radical treatment for this series included 19 patients given a combined radio-chemotherapy program and 10 patients more conservatively treated with radiation alone. Follow-up for 16 living patients ranges from 2 to 16 years. Three patients developed secondary solid tumors and four patients died of intercurrent disease free from lymphoma. The possible role of whole abdominal radiation as definitive or adjunctive therapy is discussed.