Ten years' experience with a multimodality treatment of advanced stages of rectal cancer.

Patients with inoperable rectal cancer have a remote chance of 5-year survival. In an attempt to improve this poor prognosis a combined radiochemotherapeutic regimen in a split form followed by long term chemotherapy maintenance was used in their management. From January 1971 until December 1980, three categories of patients were so treated. 100 Patients with an inoperable rectal primary (IP) or locally recurrent after anterior resection (LR) with no evidence of distant metastases; 71 patients with pelviperineal recurrences after rectal amputation (PPR); and 28 patients with primary rectal cancer and asymptomatic liver metastases (PALM). Side effects were tolerable and could be medically controlled. The local response rates in the three groups, respectively, were 79%, 85% and 85%. The median duration of this response lasted 25, 16 and 14 months, respectively, after which there was local progression of disease. The median survival rates were 19, 19 and 13 months, respectively. None of the PALM group lived for more than 30 months, while there were 20% 5-year survivors in the IP-LR group and 15% in the PPR group. The incidence of distant metastases in these last two groups were 20% and 50% at 5 years, respectively, while incidence of late complications was about 10%. This regime offers a good palliative measure with a possible 15% to 20% chance of long-term disease-free survival.

Carcinoma of the urinary bladder T3NxMo treated by preoperative irradiation followed by simple cystectomy.

One hundred eighty-three patients with bladder cancer category T3NxMo (the diameter of the primary exceeding 5 cm), were treated by preoperative 40 Gy and simple cystectomy. Using only pretreatment information, the group with the best prognosis was characterized by a T3A-growth with a normal intravenous pyelography, with about a 75% cure rate. Before cystectomy, after irradiation the combination of a clinically assessed radiation-downstaged growth (T40GY less than 3) with normal urography, predicted the best chance of cure at about 80%. After cystectomy was performed, the best prognostic group could be most correctly identified: those patients with both microscopic downstaging of the primary ("P" less than 3) and no vascular invasion in the cystectomy specimen (CV-) combined with normal urography had an 81% chance of cure. This most favorable group constitutes 45% of all patients.

The role of pre-operative adjuvant therapy in the management of borderline operability rectal cancer.

One hundred and forty-three patients with potentially operable primary rectal cancer (of stage T2, T3 and T4), were allocated to one of three regimens of therapy, i.e. surgery only (S), pre-operative radiotherapy followed by surgery (R), or pre-operative radiotherapy combined with daily intravenous fluorouracil during the first 4 days of irradiation followed by surgery (C). The adjuvant therapy was well tolerated. It had no adverse effects on surgical procedures or morbidity. There was improvement in the resectability rate C greater than R greater than S, and reduction in the incidence of Duke's C category in the surgical specimens C less than R less than S. Five-year follow-up analysis showed marked differences in the local control rates, and a reduced incidence of liver metastases in group C. There was no significant difference in survival overall between the three treatment groups, but when patients with T3 and T4 tumours were analysed separately there was a statistically significant improvement 5-year survival in group C (P less than 0.01) when compared to group S, while group R gave a marginally significant result when compared to group S (P=0.05).

Treatment of bladder cancer at the Rotterdam Radiotherapy Institute (R.R.T.I.) with special reference to bladder radium implantation and preoperative radiotherapy followed by cystectomy.

Between 1950 and 1972, a total of 2,031 cases of bladder cancer were treated in the R.R.T.I. The policy differed according to size and stage of the disease as well as to the general condition of the patient. Best results were achieved by radium implantation of solitary lesions less than 5 cms in diameter. Preoperative radiotherapy followed by cystectomy was the treatment of choice for cases of T3 category. The remaining T1 and T2 cases were treated surgically, while T4 cases were managed with external irradiation alone.

The correlation between liver scintigraphy and serum CEA levels in the detection of liver metastases from rectum carcinoma. A retrospective study.

Radiocolloid liver scintigraphy for the detection of liver metastases is widely used. Because of the known limitations of this technique we investigated the correlation between liver scintigraphy and serum CEA levels in patients with a confirmed diagnosis of primary rectum carcinoma. The serum CEA level is not suitable as a screening test for cancer, but it can be helpful as an extra parameter for the detection of liver metastases. The correlation between liver scintigraphy, the serum CEA level and the clinical findings has also been studied. A good correlation between liver scintigraphy and the serum CEA level was found. Serum CEA levels can be helpful in facilitating the evaluation of liver scintigraphy in patients with carcinoma of the rectum.

A combined therapeutic approach for the management of advanced stages of rectal cancer.

Patients with moderately advanced, inoperable, recurrent or metastatic rectal cancer, referred to the R.R.T.I. since December 1970 till December 1973, were treated with combined therapeutic regimens that differed according to the stage of the disease. Patients with border operability rectal cancer were treated with preoperative radiotherapy (with or without 5-FU combination) followed by radical surgery within two weeks. Those treated with preoperative radiotherapy + surgery (group I) showed a survival rate of 62 per cent at 48 months while those treated with combined preoperative radiotherapy + 5-FU followed by surgery (group II) showed a survival rate of 78 per cent at 48 months. As for the inoperable patients (group IV) and the recurrent cases of the rectal amputation (group V) who were treated with a split course of combined radiotherapy + 5-FU, they showed a mean survival of 20 and 48 months respectively. Patients in groups III and VI were very few to yield any meaningful results. Detailed treatment policies, techniques and results are also discussed.