Adenocarcinoma of the rectum. Results of radiotherapy and resection, endocavitary irradiation, local excision, and preoperative clinical staging.

The management of rectal cancer in 102 patients at the Jewish Hospital of St. Louis is reviewed. Therapy combining external irradiation, endocavitary irradiation, local excision, and excisional operation has been used in the treatment of adenocarcinoma of the rectum. Pretreatment evaluation for tumor fixation, ulceration, palpable presacral lymph nodes, distance of tumor from dentate line, size of tumor, and histologic grades was used to assign patients to treatment groups. Local recurrence is less than 2 percent, and two-year tumor-free survival is approximately 87 percent in patients receiving 2000 R or 4500 R preoperatively. Pathologic downstaging of tumors was noted more frequently with 4500 R preoperative irradiation. Endocavitary irradiation appears adequate to treat only favorable lesions. Only tumor fixation and histologic grade of the tumor notably affected survival. A logical plan for choosing the appropriate method of treatment using combined modalities is proposed.