title: Conservative treatment of rectal adenocarcinoma with endocavitary irradiation or wide local excision and postoperative irradiation.
abstract: OBJECTIVE
  To evaluate the role of endocavitary irradiation and wide local excision followed by irradiation in the treatment of early-stage rectal adenocarcinoma.
  
  
  METHODS
  Sixty-five patients with early-stage adenocarcinoma of the rectum were treated with endocavitary irradiation (n = 20) or wide local excision followed by external-beam irradiation (n = 45) between 1974 and 1994 at the University of Florida. All patients were monitored for a minimum of 2 years or until death.
  
  
  RESULTS
  The rates of local-regional control at 5 years were 80% after endocavitary irradiation and 86% after wide local excision and radiotherapy. The ultimate 5-year local-regional control rates were 85% and 92%, respectively. Multivariate analysis of local-regional control with sphincter preservation showed that tumor configuration (exophytic v ulcerative) significantly influenced this end point; local-regional control was decreased in patients with ulcerated cancers. Five-year cause-specific survival rates were 84% after endocavitary irradiation and 88% after wide local excision and radiotherapy. Multivariate analysis revealed that tumor configuration significantly influenced cause-specific survival; patients with ulcerated tumors had a worse prognosis.
  
  
  CONCLUSIONS
  Endocavitary irradiation is a highly effective treatment for properly selected patients with early-stage rectal adenocarcinoma. Patients with less favorable lesions that appear to be limited to the muscularis propria have a high chance of cure with sphincter preservation after wide local excision and external-beam irradiation.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, 32510-0385, USA. mendewil.radonc@shands.ufl.edu
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: W R
authors.initials: WR
authors.lastname: Rout
authors.forename: J N
authors.initials: JN
authors.lastname: Vauthey
authors.forename: L S
authors.initials: LS
authors.lastname: Haigh
authors.forename: R A
authors.initials: RA
authors.lastname: Zlotecki
authors.forename: E M
authors.initials: EM
authors.lastname: Copeland
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D001918:Brachytherapy; D003131:Combined Modality Therapy; D006801:Humans; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate