COMBINED CURATIVE RADIATION-THERAPY ALONE IN (T1) T2-3 RECTAL ADENOCARCINOMA - A PILOT-STUDY OF 29 PATIENTS

Aim: Analysis of a pilot study including 29 consecutive patients with high surgical risk or refusal of colostomy treated with radiation ther apy alone with curative intent. Patients: Between 1986 and 1992, 29 pa tients were treated for infiltrating adenocarcinoma of the rectum. Med ian age was 72 years. Transrectal ultrasound staging was used in 24 pa tients (T1, 2; T2, 14; T3, 13; N0, 23; N1, 6). In 20 patients the lowe r border of the tumor was at 5 cm or less from the anal verge and in 1 9 patients the diameter exceeded 3 cm. CEA was elevated in seven cases . Treatment: Contact X-ray (50 kV) was given first (70 Gy/3 fractions) . External beam radiation therapy used a three-field technique in the prone position. Accelerated schedule (39 Gy/13 fractions/17 days) with a concomitant boost 'field within the field' (4 Gy/4 fractions). Six weeks later an iridium-192 implant was performed in 21 (20 Gy/22 h). R esults: Median follow-up time was 46 months. Overall and specific surv ival at 5 years was 68% (SE = 0.09) and 76% (SE = 0.08). Local control was obtained in 21/29 patients (72%). There was one grade 2 rectal bl eeding and five grade 2 rectal necroses. The overall tolerance was goo d in these frail patients. Discussion: For T2. T3 or T1 > 3 cm diamete r rectal adenocarcinoma, where contact X-ray alone is not recommended, a combined treatment with radiation therapy alone is able to give goo d local control with acceptable toxicity. This treatment should be res tricted to inoperable patients.