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Combination preoperative radiation with chemotherapy in carcinomas of the rectum and anus
Side effects have been largely and generalized abdominal carcinomatoses). limited to mild nausea and some depression in bone marrow function, especially thrombocytopenia requiring 5-FU dose reduction but no other measures. We are currently evaluating increased 5-FU levels since tolerance has not been reached. The study shows that (a) this biweekly combination is welltolerated and 1 week bone marrow and mucosal recovery is sufficient; (b) continuous XRT is not necessarily optimal in combined therapy with cycle active chemotherapy; (c) in pts. followed up to 21 months no major complications have been noted. Results in individual stratification groups will be reviewed and organ tolerance described for this new regimen. Supported by CM-43791, CALGB and UCSD Ca. Center funds.
(92)
COMBINATION PREOPERATIVE RADIATION WITH CHEMOTHERAPY OF THE RECTUM AND ANUS
IN CARCINOMAS
Sischy, B., Remington, J., Sobel, S. and Savlov, E. Daisy Marquis Jones Radiation Oncology Center of Highland Hospital Rochester, New York 14620 We believe that the following combined approach is an example of what can now be achieved by the cooperative effort of chemotherapy, x-ray therapy and surgery. Chemotherapy consisting of 5FU, given as a continuous 24-hour infusion for four days and Mitomycin C, given as a bolus intravenous injection, and radiation therapy are all started on day 1. Radiation therapy is continued Low-lying rectal lesions and anal until a dose of 4000 rads is delivered. lesions receive an additional incident dose of 1000 rads by means of a direct perineal field. Intravenous 5FU is repeated on day 28, and continued for four days again as a continuous infusion. All patients are judged, clinically, to be candidates for curative abdominoperineal resection. This is performed during the fourth week following the completion of radiation therapy. The chemotherapy is well tolerated and the surgery has not presented any particular problems. We now have experience with more than 29 patients. Although all the rectal carcinomas were large, there was a diminution in size in all the cases and in half the cases there was at least a 50% reduction in the size of the original lesion. In a number of cases there has been no tumor or only minimal residual disease remaining at the time of surgery. There has also been a remarkable increase in the number of Dukes' A lesions found at surgery. In squamous cell carcinoma of the anus, all patients have been found to be free of disease at surgery. Although the experience reported will be only that of two years, our preliminary results are such that we have no hesitancy in reporting our findings. We feel that earnest consideration should be given to this interdisciplineary management of rectal and anal carcinomas.
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(92)
COMBINATION PREOPERATIVE RADIATION WITH CHEMOTHERAPY OF THE RECTUM AND ANUS
IN CARCINOMAS
Sischy, B., Remington, J., Sobel, S. and Savlov, E. Daisy Marquis Jones Radiation Oncology Center of Highland Hospital Rochester, New York 14620 We believe that the following combined approach is an example of what can now be achieved by the cooperative effort of chemotherapy, x-ray therapy and surgery. Chemotherapy consisting of 5FU, given as a continuous 24-hour infusion for four days and Mitomycin C, given as a bolus intravenous injection, and radiation therapy are all started on day 1. Radiation therapy is continued Low-lying rectal lesions and anal until a dose of 4000 rads is delivered. lesions receive an additional incident dose of 1000 rads by means of a direct perineal field. Intravenous 5FU is repeated on day 28, and continued for four days again as a continuous infusion. All patients are judged, clinically, to be candidates for curative abdominoperineal resection. This is performed during the fourth week following the completion of radiation therapy. The chemotherapy is well tolerated and the surgery has not presented any particular problems. We now have experience with more than 29 patients. Although all the rectal carcinomas were large, there was a diminution in size in all the cases and in half the cases there was at least a 50% reduction in the size of the original lesion. In a number of cases there has been no tumor or only minimal residual disease remaining at the time of surgery. There has also been a remarkable increase in the number of Dukes' A lesions found at surgery. In squamous cell carcinoma of the anus, all patients have been found to be free of disease at surgery. Although the experience reported will be only that of two years, our preliminary results are such that we have no hesitancy in reporting our findings. We feel that earnest consideration should be given to this interdisciplineary management of rectal and anal carcinomas.
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