Combined curative radiation therapy alone in (T1) T2-3 rectal adenocarcinoma: a pilot study of 29 patients.
OBJECTIVE
Analysis of a pilot study including 29 consecutive patients with high surgical risk or refusal of colostomy treated with radiation therapy alone with curative intent.


METHODS
Between 1986 and 1992, 29 patients were treated for infiltrating adenocarcinoma of the rectum. Median age was 72 years. Transrectal ultrasound staging was used in 24 patients (T1, 2; T2, 14; T3, 13; N0, 23; N1, 6). In 20 patients the lower border of the tumor was at 5 cm or less from the anal verge and in 19 patients the diameter exceeded 3 cm. CEA was elevated in seven cases.


METHODS
Contact X-ray (50 kV) was given first (70 Gy/3 fractions). External beam radiation therapy used a three-field technique in the prone position. Accelerated schedule (39 Gy/13 fractions/17 days) with a concomitant boost "field within the field' (4 Gy/4 fractions). Six weeks later an iridium-192 implant was performed in 21 (20 Gy/22 h).


RESULTS
Median follow-up time was 46 months. Overall and specific survival at 5 years was 68% (SE = 0.09) and 76% (SE = 0.08). Local control was obtained in 21/29 patients (72%). There was one grade 2 rectal bleeding and five grade 2 rectal necroses. The overall tolerance was good in these frail patients.


CONCLUSIONS
For T2. T3 or T1 > 3 cm diameter rectal adenocarcinoma, where contact X-ray alone is not recommended, a combined treatment with radiation therapy alone is able to give good local control with acceptable toxicity. This treatment should be restricted to inoperable patients.
Gerard
J P
JP
Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon Sud, Pierre Benite, France.
Roy
P
P
Coquard
R
R
Barbet
N
N
Romestaing
P
P
Ayzac
L
L
Ardiet
J M
JM
Thalabard
J C
JC
D000230:Adenocarcinoma / Q000453:epidemiology / Q000532:radiotherapy*; D000368:Aged; D001918:Brachytherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014964:X-Ray Therapy
D007496:Iridium Radioisotopes