Radiation enhancement of laser palliation for advanced rectal and rectosigmoid cancer: a pilot study.

Laser palliation for advanced rectal or rectosigmoid cancer requires repeat treatments every four to six weeks. Thirteen patients (seven men, six women) age range 65-91 (median 81) received additional external beam radiotherapy in an attempt to reduce the frequency of laser treatments required. After successful laser recanalisation, patients were treated with a dose of 30-55 Gy in 10-20 fractions. Bowel symptoms were well controlled for prolonged periods in 11 patients (85%) and further laser procedures were only required every 19 weeks median (range 6-53 weeks). The laser energy required after radiotherapy was only 800 J/month (median). Survival was 14 months (median, range 2.5-20 months) for the seven patients who have died. Seven patients received laser treatment only for three months or more (median 14 weeks, range 13-39). In this group control of symptoms required procedures every four weeks (median) before radiotherapy and 20 weeks (median) afterwards. The laser energy required before radiotherapy was 15,000 J/month and 2000 J/month afterwards (Wilcoxon rank sum test, p < 0.01 for both). Radiotherapy was well tolerated in all but one patient. Three patients developed strictures after radiotherapy but all were dealt with endoscopically. There were no complications solely due to endoscopic procedures. Additional radiotherapy enhances laser palliation for inoperable rectal or rectosigmoid cancer.