THE INFLUENCE OF LOCAL TUMOR ULCERATION ON THE EFFECTIVENESS OF ENDOCAVITARY RADIATION FOR PATIENTS WITH EARLY RECTAL-CARCINOMA

Background. Endocavitary radiation therapy is an alternative to surgic al therapy for some early rectal carcinomas. Careful patient selection is necessary to ensure good results. The purpose of this study was to examine the authors' experience with endocavitary radiation at their institution from 1984 to 1991 to determine which factors were associat ed with treatment failure to provide for better future patient selecti on. Methods. Thirty-two patients with carcinoma of the rectum, not app arently involving the muscle wall, underwent 75-120 Gy of endocavitary radiation as potentially curative therapy. Treatment was given as a s eries of 2-4 doses of 30 Gy at three weekly intervals. Twenty-two pati ents had polypoid tumors, 5 sessile, and 5 ulcerated. Results. After a mean follow-up of 43 months (range, 6-103 months), 4 of 5 patients (8 0%) with ulcerated tumors developed local recurrences, compared with o nly 4 of 27 (15%) with sessile or polypoid lesions. Not only was the i ncidence of local recurrence greater for patients with ulcerated tumor s (P = 0.009), but the time to recurrence was shorter also (P = 0.0001 ). Tumor size, anterior or posterior location, and dose of radiation r eceived did not affect the rate of recurrence. Conclusions. These resu lts indicate that superficial polypoid and sessile rectal tumors can b e managed successfully with endocavitary radiation. Ulcerating tumors are likely to recur locally within a short time and therefore should b e considered for surgical treatment initially.