ENDOCAVITARY IR-192 RADIATION AND LASER TREATMENT FOR PALLIATION OF OBSTRUCTIVE RECTAL-CANCER

Endoscopic laser therapy (ELT) either alone or combined with endocavit ary Ir-192 radiation is performed for advanced, inoperable rectal canc er and when patients are ineligible for surgery, due to severe concomi tant medical illness, During the period from January 1984 to January 1 997 we treated 81 patients (51 males, 30 females), Sixty-seven patient s had ELT only using a ND-Yag Laser system, Twenty-five patients (aver age age: 80.5 years) were ineligible for surgery (Group I). Forty-two patients (74.1 years) had an advanced locally inoperable tumour (Group II). Fourteen patients (76.5 years) underwent a combined therapeutic regime with endocavitary. Ir-192 afterloading following ELT (Group III ). adequate desobliteration was achieved in 100% (groups I and III) an d 97% (group II) of the patients, The average interval to aftertreatme nt was 8.4 weeks in group I and 9.4 weeks in group II, compared to 11. 5 weeks in group III. Serious complications (perianal abscess, rectova ginal fistula) occurred in 3.7%, minor complications (laser-induced bl eedings, unclear fever) in 12.3%. All laser-induced bleedings could be dealt with using laser therapy. The frequency of treatment was govern ed by tumour mass and the patient's survival. The results suggest that additional endocavitary radiation significantly prolongs the maintena nce of normal bowel function compared with laser therapy alone.