Abstract
Surgery is the modality of choice in curative treatment for cancer of the colon and rectum. Since a majority of the patients present advanced disease where the surgical outlook is poor, adjuvant therapy may be warranted. Clinical and experimental data demonstrate the benefits from preoperative radiation therapy and some clinical reports indicate the beneficial effects of postoperative radiotherapy. Two national studies are underway to determine the effectiveness of preoperative radiation therapy in moderate doses. A similar study is suggested to establish the effectiveness of postoperative radiation therapy.
For patients who are poor surgical risks, or for a tumor which is considered to be inoperable, and in a selected group, radiation therapy can be used as a curative procedure. Advantages include eliminating the need for a permanent colostomy. In case of failure, electrocoagulation and abdominal perineal resection are still available alternatives.
A modest amount of radiation therapy can afford maximum palliation with minimum discomfort to the patient. About 80-90 percent of patients with pain and bleeding and 50 percent of patients with symptomatic liver metastasis respond favorably.
Full text
PDF



Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- AGOSTINO D., NICKSON J. J. Preoperative x-ray therapy in a simulated colon carcinoma in the rat. Radiology. 1960 May;74:816–819. doi: 10.1148/74.5.816. [DOI] [PubMed] [Google Scholar]
- ASTLER V. B., COLLER F. A. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg. 1954 Jun;139(6):846–852. doi: 10.1097/00000658-195406000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Allen C. V., Fletcher W. S. A pilot study on preoperative irradiation of rectosigmoid carcinoma. Am J Roentgenol Radium Ther Nucl Med. 1972 Mar;114(3):504–508. doi: 10.2214/ajr.114.3.504. [DOI] [PubMed] [Google Scholar]
- BERGONIE J., TRIBONDEAU L. Interpretation of some results of radiotherapy and an attempt at determining a logical technique of treatment. Radiat Res. 1959 Oct;11:587–588. [PubMed] [Google Scholar]
- Dedkov I. P., Zibina M. A. Intensive preoperative gamma-therapy in combined treatment of cancer of the rectum. Am J Proctol. 1976 Dec;27(6):43–47. [PubMed] [Google Scholar]
- FLOYD C. E., CORLEY R. G., COHN I., Jr LOCAL RECURRENCE OF CARCINOMA OF THE COLON AND RECTUM. Am J Surg. 1965 Feb;109:153–159. doi: 10.1016/s0002-9610(65)80138-6. [DOI] [PubMed] [Google Scholar]
- Fletcher G. H. Elective irradiation of subclinical disease in cancers of the head and neck. Cancer. 1972 Jun;29(6):1450–1454. doi: 10.1002/1097-0142(197206)29:6<1450::aid-cncr2820290605>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
- Fletcher G. H. Local results of irradiation in the primary management of localized breast cancer. Cancer. 1972 Mar;29(3):545–551. doi: 10.1002/1097-0142(197203)29:3<545::aid-cncr2820290302>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
- Floyd C. E., Stirling C. T., Cohn I., Jr Cancer of the colon, rectum and anus: review of 1,687 cases. Ann Surg. 1966 Jun;163(6):829–837. doi: 10.1097/00000658-196606000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gunderson L. L., Sosin H. Areas of failure found at reoperation (second or symptomatic look) following "curative surgery" for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer. 1974 Oct;34(4):1278–1292. doi: 10.1002/1097-0142(197410)34:4<1278::aid-cncr2820340440>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
- HORWITZ H., WILLIAMS I. G. The primary treatment of adenocarcinoma of the rectum by high voltage roentgen rays (1,000 kv). Am J Roentgenol Radium Ther Nucl Med. 1956 Nov;76(5):919–928. [PubMed] [Google Scholar]
- INCH W. R., McCREDIE J. A. Effect of a small dose of x-radiation on local recurrence of tumors in rats and mice. Cancer. 1963 May;16:595–598. doi: 10.1002/1097-0142(196305)16:5<595::aid-cncr2820160508>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
- Jelden G., Dhaliwal R., Rodriguez-Antunez A., Chernak E., Turnbull R., Fazio V., Weakley F. Definitive treatment of carcinoma of the rectum by intracavitary radiation therapy. AJR Am J Roentgenol. 1976 Apr;126(4):877–879. doi: 10.2214/ajr.126.4.877. [DOI] [PubMed] [Google Scholar]
- Kligerman M. M., Urdaneta N., Knowlton A., Vidone R., Hartman P. V., Vera R. Preoperative irradiation of rectosigmoid carcinoma including its regional lymph nodes. Am J Roentgenol Radium Ther Nucl Med. 1972 Mar;114(3):498–503. doi: 10.2214/ajr.114.3.498. [DOI] [PubMed] [Google Scholar]
- LEAMING R. H., STEARNS M. W., DEDDISH M. R. Preoperative irradiation in rectal carcinoma. Radiology. 1961 Aug;77:257–263. doi: 10.1148/77.2.257. [DOI] [PubMed] [Google Scholar]
- Lindberg R. D., Martin R. G., Romsdahl M. M. Surgery and postoperative radiotherapy in the treatment of soft tissue sarcomas in adults. Am J Roentgenol Radium Ther Nucl Med. 1975 Jan;123(1):123–129. doi: 10.2214/ajr.123.1.123. [DOI] [PubMed] [Google Scholar]
- Mendiondo O. A., Wang C. C., Welch J. P., Donaldson G. A. Postoperative radiotherapy in carcinomas of the rectum and distal sigmoid colon. Radiology. 1976 Jun;119(3):673–676. doi: 10.1148/119.3.673. [DOI] [PubMed] [Google Scholar]
- Morson B. C., Vaughan E. G., Bussey H. J. Pelvic Recurrence after Excision of Rectum for Carcinoma. Br Med J. 1963 Jul 6;2(5348):13–18. doi: 10.1136/bmj.2.5348.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- POWERS W. E., TOLMACH L. J. PRE-OPERATIVE RADIATION THERAPY: BIOLOGICAL BASIS AND EXPERIMENTAL INVESTIGATION. Nature. 1964 Jan 18;201:272–273. doi: 10.1038/201272a0. [DOI] [PubMed] [Google Scholar]
- Papillon J. Intracavitary irradiation of early rectal cancer for cure. A series of 186 cases. Cancer. 1975 Aug;36(2):696–701. doi: 10.1002/1097-0142(197508)36:2+<696::aid-cncr2820360813>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
- RUFF C. C., DOCKERTY M. B., FRICKE R. E., WAUGH J. M. Preoperative radiation therapy for adenocarcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet. 1961 Jun;112:715–723. [PubMed] [Google Scholar]
- Rider W. D., Palmer J. A., Mahoney L. J., Robertson C. T. Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. Can J Surg. 1977 Jul;20(4):335–338. [PubMed] [Google Scholar]
- Rodriguez-Antúnez A., Chernak E. S., Jelden G. L., Hunter T. W. Preoperative irradiation of carcinoma of the rectum. Radiology. 1973 Sep;108(3):689–690. doi: 10.1148/108.3.689. [DOI] [PubMed] [Google Scholar]
- Roswit B., Higgins G. A., Keehn R. J. Preoperative irradiation for carcinoma of the rectum and rectosigmoid colon: reportof a National Veterans Administration randomized study. Cancer. 1975 Jun;35(6):1597–1602. doi: 10.1002/1097-0142(197506)35:6<1597::aid-cncr2820350618>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
- STEARNS M. W., Jr, DEDDISH M. R., QUAN S. H. Preoperative roentgen therapy for cancer of the rectum. Surg Gynecol Obstet. 1959 Aug;109(2):225–229. [PubMed] [Google Scholar]
- Smedal M. I., Wright K. A., Siber F. J. The palliative treatment of recurrent carcinoma of rectum and rectosigmoid with 2 mv. radiation. Some results and description of a technique. Am J Roentgenol Radium Ther Nucl Med. 1967 Aug;100(4):904–908. [PubMed] [Google Scholar]
- Stearns M. W., Jr, Deddish M. R., Quan S. H. Preoperative irradiation for cancer of the rectum and rectosigmoid: preliminary review of recent experience (1957-1962). Dis Colon Rectum. 1968 Jul-Aug;11(4):281–284. doi: 10.1007/BF02617155. [DOI] [PubMed] [Google Scholar]
- Stevens K. R., Jr, Allen C. V., Fletcher W. S. Preoperative radiotherapy for adenocarcinoma of the rectosigmoid. Cancer. 1976 Jun;37(6):2866–2874. doi: 10.1002/1097-0142(197606)37:6<2866::aid-cncr2820370644>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
- Tepper M., Vidone R. A., Hayes M. A., Lindenmuth W. W., Kligerman M. M. Preoperative irradiation in rectal cancer: initial comparison of clinical tolerance, surgical and pathologic findings. Am J Roentgenol Radium Ther Nucl Med. 1968 Mar;102(3):587–595. doi: 10.2214/ajr.102.3.587. [DOI] [PubMed] [Google Scholar]
- Turner S. S., Vieira E. F., Ager P. J., Alpert S., Efron G., Ragins H., Weil P., Ghossein N. A. Elective postoperative radiotherapy for locally advanced colorectal cancer. A preliminary report. Cancer. 1977 Jul;40(1):105–108. doi: 10.1002/1097-0142(197707)40:1<105::aid-cncr2820400119>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
- Urdaneta-Lafee N., Kligerman M. M., Knowlton A. H. Evaluation of palliative irradiation in rectal carcinoma. Radiology. 1972 Sep;104(3):673–677. doi: 10.1148/104.3.673. [DOI] [PubMed] [Google Scholar]
- WANG C. C., SCHULZ M. D. The role of radiation therapy in the management of carcinoma of the sigmoid, rectosigmoid, and rectum. Radiology. 1962 Jul;79:1–5. doi: 10.1148/79.1.1. [DOI] [PubMed] [Google Scholar]
- Whiteley H. W., Jr, Stearns M. W., Jr, Leaming R. H., Deddish M. R. Radiation therapy in the palliative management of patients with recurrent cancer of the rectum and colon. Surg Clin North Am. 1969 Apr;49(2):381–387. doi: 10.1016/s0039-6109(16)38795-3. [DOI] [PubMed] [Google Scholar]
- Withers H. R., Romsdahl M. M. Post-operative radiotherapy for adenocarcinoma of the rectum and rectosigmoid. Int J Radiat Oncol Biol Phys. 1977 Nov-Dec;2(11-12):1069–1074. doi: 10.1016/0360-3016(77)90111-0. [DOI] [PubMed] [Google Scholar]
