Combination preoperative radiation and endocavitary hyperthermia for rectal cancer: long-term results of 44 patients.

Long-term results of 122 patients with advanced rectal cancer who were randomly treated with three different methods from July 1984 to July 1986. Of 122 patients, 44 were treated with endocavitary 915 MHz microwave applicators combined with 10 MeV X-ray or 60CO followed by surgery (group A), 38 with preoperative radiation (group B) and 40 with surgery (group C) as a control group. The temperature on the surface of the applicator touching the middle of the caudad to cephaladic extent of disease was 45-50 degrees C for 45 min twice a week for 6-8 sessions. Radiation dose was 30 Gy or 40 Gy/4 weeks. Of cases with stages 0 and A, 45.5% (20/44) were in group A, 23.7% (9/38) in group B and 12.5% (5/40) in group C (chi 2 test p < 0.05 and p < 0.01, respectively). Five-year survival rate was 66.7% (24/36) in group A, 50% (14/28) in group B and 40.5% (15/37) in group C. Percentage of survival at 5 years was 73.7% (14/19) for 40 Gy plus heat, 57.1% (8/14) for 40 Gy alone, 58.8% (10/17) for 30 Gy plus heat, and 42.9% (6/14) for 30 Gy alone. Data suggest a survival advantage for patients treated with preoperative radiation combined with endocavitary hyperthermia.

[Clinicopathological study of combined preoperative radiotherapy with intracavitary hyperthermia in rectal cancer].

118 specimens of rectal cancer were studied pathologically. 40 cases were treated by both preoperative radiotherapy and intracavitary hyperthermia (group 1), 38 treated by preoperative radiotherapy alone (group 2) and 40 by operation alone (group 3). The tumor disappearance rates by gross observation were 57.5% and 5.3% in groups 1 and 2 (P less than 0.001). The moderate to severe damage of cancer cells (X2-X4) was observed in 90% of cases in group 1 and 31.6% in group 2 (P less than 0.05). In the former, the cancer cell disappearance was observed in 8 cases, while in the latter, only 1 case. The cell degenerations by 30 Gy plus hyperthermia were similar to those by 40 Gy plus hyperthermia, but both were more marked than by 30 Gy alone or 40 Gy alone (P less than 0.05). The lymphocyte, plasma cell infiltration and hyperplasia of fibrous tissue around the tumor in group 1 were more marked than those in groups 2 and 3 (P less than 0.05). The thrombosis around the tumor was more in group 1 than in group 2 (P less than 0.01). Every histological type of the tumor was sensitive to radiotherapy combined with hyperthermia. The lymph node metastatic rates were 35% in group 1 and 31.6% in group 2, both being lower than that in group 3 (52.5%). Immune function of the lymph nodes and the damage of the normal tissues around the tumor are observed. It has been clinically confirmed that neither resection rate is influenced nor postoperative complications are increased by preoperative radiotherapy combined with hyperthermia.

[Combination of radiation, chemotherapy and surgery in rectal cancer--an analysis of 128 patients].

The results of 128 patients with rectal cancer treated by the combination of surgery, preoperative radiotherapy and chemotherapy from June 1975 to December 1979 are reported and compared with those by operation alone. The 5 year survival rates of the different groups were: 69.5% (16/23) for radical surgery plus preoperative radiotherapy and chemotherapy (RRCG), 56% (14/25) for radical surgery plus preoperative radiotherapy, 53.8% (7/13) for radical surgery plus chemotherapy and 40% (10/25) for radical surgery alone. The 5 year survival rate of RRCG was significantly higher than that of the radical surgery alone group (P less than 0.05). The authors believe that the combination of preoperative radiotherapy, chemotherapy plus radical surgery improves the 5 year survival rate and is worthy of further study.