New prospects in the conservative treatment of rectal cancer

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Abstract
Conservative treatment of rectal cancer is applicable only to limited tumors that are assumed to have no lymphatic spread; these are well or moderately well differentiated adenocarcinomas confined to the bowel wall, without palpable pararectal metastatic lymph nodes. The experience of intracavitary irradiation (contact X-ray therapy often combined with 192Ir implant), based on 245 patients followed for more than 5 yr, shows a low rate of local failure (5.3%). The rate of death from cancer is 8.9% and the 5-yr survival rate is 76%. In patients under 60 yr, a perirectal lymphadenectomy should be considered a safety measure. A new approach, based on a combination of external beam irradiation (3000 rad in 12 days), followed 192Ir implant 2 mo. later, allows the field of conservative treatment in poor-risk surgical patients to be extended without jeopardizing their chance of cure.