Papillon J
Cancer. 1975 Aug;36(2):696-701. doi: 10.1002/1097-0142(197508)36:2+<696::aid-cncr2820360813>3.0.co;2-x.
If radical surgery is the only rational policy for most cases of rectal cancer, the problem of local treatment in poor surgical risk patients should be discussed in selected cases. Only limited, fairly-well-differentiated tumors, still confined to the rectal wall may have a sufficiently low probability of lymphatic spread to be amenable to local treatment. Rectal cancer, usually regarded as being slightly radiosensitive when treated by external irradiation, proves to be highly radiosensitive in the case of early cancer treated by intracavitary irradiation. This method is able to control a large amount of limited polypoid and ulcerative adenocarcinomas. In a series of 133 cases followed more than 5 years, the rate of death from cancer is only 9%, and the 5-year survival rate is 78%. As compared with local exision or electrocoagulation, intracavitary irradiation has several advantages. It does not require colostomy nor anesthesia. Contact x-ray therapy is an ambulatory treatment applicable even to elderly and fragile patients. There is no danger of fistula in the case of tumor of the anterior wall in female patients. It preserves all the chances of cure by subsequent surgery in case of failure.
如果根治性手术是大多数直肠癌病例唯一合理的治疗策略，那么对于手术风险高的患者的局部治疗问题应在特定病例中进行讨论。只有那些局限于直肠壁、分化程度较好且范围有限的肿瘤，其淋巴转移的可能性才足够低，适合进行局部治疗。直肠癌通常被认为在接受外照射治疗时对放疗的敏感性稍低，但对于通过腔内照射治疗的早期癌症，其对放疗高度敏感。这种方法能够控制大量局限的息肉状和溃疡性腺癌。在一组133例随访超过5年的病例中，癌症死亡率仅为9%，5年生存率为78%。与局部切除或电凝术相比，腔内照射有几个优点。它不需要结肠造口术，也不需要麻醉。接触X线治疗是一种门诊治疗，甚至适用于年老体弱的患者。女性患者前壁肿瘤不会有发生瘘管的危险。如果治疗失败，它保留了后续手术治愈的所有机会。
