ENDOCAVITARY IRRADIATION - AN OPTION IN SELECT PATIENTS WITH RECTAL-CANCER

PURPOSE: Endocavitary irradiation delivers high-dose irradiation with limited penetration and is an established modality for the curative tr eatment of select tumors. The purpose of this study was to review the experience from our institution with endocavitary irradiation. METHODS : All patients with rectal cancer treated with endocavitary irradiatio n between 1973 and 1992 were studied. Collected data included: tumor s ize, tumor differentiation, distance from the anal verge, mean follow- up, recurrence, and other treatments used. RESULTS: One hundred ninety -nine patients received endocavitary irradiation, with 126 treated wit h curative intent. No significant differences were found between group s with recurrence and no recurrence when examining tumor size, differe ntiation, distance from the anal verge, or follow-up. With a mean time to recurrence of 16.1 (range, 1-56) months, 37/126 patients had a rec urrence, and 89/126 had no recurrence. Ten recurrences were distant, a nd all patients died of the disease. Twenty-seven patients had local r ecurrence. Following additional treatments, 14 additional patients wer e rendered free of disease. CONCLUSION: Endocavitary irradiation initi ally rendered 71 percent (89/126) free of disease. With additional tre atment 11 percent (14/126) were rendered free of disease. In the subgr oup of patients followed more than five years, 68 percent had no evide nce of disease at followup after endocavitary irradiation, and 91 perc ent: had no evidence of disease with additional treatment. Tumor size, differentiation, morphology, and distance from the anal verge did not influence recurrence. Debulking or surgical excision before endocavit ary irradiation did not increase recurrence. Diligent long-term follow -up and a liberal policy to biopsy suspicious areas may increase the s alvage rate.