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Skin toxicity caused by radiotherapy has been visually classified into discrete grades. The present study proposes an objective and continuous assessment method of skin erythema in digital images taken under arbitrary lighting conditions, which is the case for most clinical environments. The purpose of this paper is to show the feasibility of the proposed method.Clinical data were gathered from six patients who received carbon beam therapy for lung cancer. Skin condition was recorded using an ordinary compact digital camera under unfixed lighting conditions; a laser Doppler flowmeter was used to measure blood flow in the skin. The photos and measurements were taken at 3 h, 30, and 90 days after irradiation. Images were decomposed into hemoglobin and melanin colors using independent component analysis. Pixel values in hemoglobin color images were compared with skin dose and skin blood flow. The uncertainty of the practical photographic method was also studied in nonclinical experiments.The clinical data showed good linearity between skin dose, skin blood flow, and pixel value in the hemoglobin color images; their correlation coefficients were larger than 0.7. It was deduced from the nonclinical that the uncertainty due to the proposed method with photography was 15%; such an uncertainty was not critical for assessment of skin erythema in practical use.Feasibility of the proposed method for assessment of skin erythema using digital images was demonstrated. The numerical relationship obtained helped to predict skin erythema by artificial processing of skin images. Although the proposed method using photographs taken under unfixed lighting conditions increased the uncertainty of skin information in the images, it was shown to be powerful for the assessment of skin conditions because of its flexibility and adaptability.

We report the case of a patient with invasive uterine cervical carcinoma, who is also infected with human immunodeficiency virus. This patient has had the longest progression-free survival of any with acquired immunodeficiency syndrome uterine cervical carcinoma. She was found to be human immunodeficiency virus positive in February 1996 and found to have uterine cervical carcinoma stage IB in July 1996. Shortly thereafter, she underwent radiation therapy. She died of renal and liver failure in January 1999. However, no residual tumor existed at that time. The longest progression-free survival in this case may be attributable to maintenance of the CD4 cell count from the onset of uterine cervical carcinoma to death, which meant the patient's immune system to the cancer cells worked.

This study was designed to evaluate the concomitant use of docetaxel and carboplatin for radiosensitization in head and neck cancer.One dose of docetaxel at 10 mg/m2 and five doses of carboplatin at AUC of 0.4 per week were administered to patients during the first two weeks of radiotherapy. Sixteen patients were treated with this regimen. Radiotherapy was given to a total dose of 64.8 to 82.0 Gy. Altered fractionation radiotherapy was performed in 12 patients with untreated advanced tumors.The complete response (CR) rate was 81%, with a partial response (PR) rate of 19%. Toxicities included grade 3 mucositis in 69% of patients and grade 2 dermatitis in 56% of patients.This schedule of docetaxel and carboplatin combined with radiotherapy may become a useful approach for the management of head and neck cancer with proper management of mucositis.

A 36-year-old woman admitted to our hospital because of numbness in the left limbs and weakness in the right arm, and was subsequently given a diagnosis of intramedullary spinal cord metastases from lung cancer. The patient had lung adenocarcinoma with metastases to the brain, spine and lymph nodes. Occipital craniotomy, radiation therapy and chemotherapy were performed on the lesions in the year following June 1994. In June 1995, however, she complained of numbness in the left limbs and weakness in the right arm. Compatible with her neurological manifestation, MRI demonstrated tumors in the right side of the cord at the spinal level of C3-4 and C7-Th1, both of which were of high density in T2-enhanced conditions with enhancement by gadolinium-diethylenetriamine pentaacetic acid. No invasion from spinal metastasis was detected by CT, scintigraphy or MRI. We therefore diagnosed her manifestation as Brown-Séquard syndrome caused by intramedullary spinal cord metastatic tumors of lung adenocarcinoma. In order to avoid paraplegia and dysfunction of the bladder and bowel, radiation therapy of the cord lesions with total dose of 44 Gy was performed. Her neurologic manifestation was improved, restoring her quality of life, as the tumor size estimated by MRI decreased. Four months later, however, she died of lung adenocarcinoma that developed accompanied with severe peritonitis carcinomatosa and multiple metastases.

Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5 +/- 6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease.Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR).The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33 +/- 0.22 in chronic heart failure class I, 2.50 +/- 0.34 in class II, 1.95 +/- 0.61 in class III, and 1.39 +/- 0.29 in class IV (p0.05). %WR was 24.8 +/- 12.8% in chronic heart failure class I, 23.3 +/- 10.2% in class II, 49.2 +/- 24.5% in class III, and 66.3 +/- 26.5% in class IV (p0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure.Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure.

We analyzed 58 cases of advanced or recurrent cervical cancer treated with intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. Two separate IAIC regimens were administered since 1985: group I consisted of 5-FU + MMC +/- ADR (30 patients) and group II consisted of CDDP + MMC +/- 5-FU (28 patients). The tip of a catheter was placed in the bifurcation of the abdominal aorta (1 way method: 45 patients regimen II: 15) between 1977-1984. We have used selective catheterization (2 ways method: 9) since 1995 in order to get good drug distribution. However we experienced grade 4 toxic effect of cutaneous and pain with this method, so we have used a 3 ways method (4 patients) since 1998. The two-year survival rete was 60% with the 1 way method, and 67% with the 2 ways method and regimen II. Severe adverse effects (grade 3 + 4) were found in 53, 56, 0%, respectively, by each of the three methods (1, 2, 3 ways) hematologically, 13, 22, 0% in gastrointestinally, 0, 44, 0% in cutaneously and 0, 56, 0% in pain or neurotoxicity. These data suggest that IAIC by the 3 ways method is a useful treatment for advanced or recurrent cervical cancer. However, one should check the blood flow distribution periodically, and control concentration of drugs.

This report describes a patient with acute-type adult T cell leukemia/lymphoma (ATLL) successfully treated by autologous CD34+ peripheral blood stem cell transplantation after fractionated total body irradiation and high-dose cytarabine and cyclophosphamide. A newly established inverse polymerase chain reaction method was used to demonstrate the disappearance of ATLL clonal cells. The patient achieved a sustained molecular remission after transplantation, but died from opportunistic infection 4 months after transplantation. Thus, autologous CD34+ peripheral blood stem cell transplantation is promising for this type of malignancy. However, a prudent clinical attitude toward immunological fragility after transplantation is needed for better outcome.

The efficacy of intraoperative radiotherapy (IORT) for the local recurrence of rectal cancer was evaluated. Operations were performed for a total of 43 patients with local recurrence of rectal cancer, and among them 13 cases received IORT. These patients were divided into two groups those with a suspicion of cancer remaining in the surgical margin macroscopically (EW+ group) or those with no such suspicion (EW- group). The length of pain relieving period and total survival between the IORT and no IORT groups in EW- patients showed no statistical difference. Though the same result was found in EW+ patients, in the patients whose area of positive surgical margin was less than 10 cm2 and given IORT, the pain relief period was prolonged compared with the no IORT patients such as 270 days v.s. 218 days. IORT did not show efficacy in terms of the survival period, but if the local remnant area was small, it was beneficial for the patients in terms of the pain period.

Sixty-three patients with squamous cell carcinoma of the hypopharynx were treated at the University of Tokyo between 1985 and 1993. Twelve patients were treated with surgery alone, 16 with preoperative irradiation, 26 with postoperative irradiation, and nine with irradiation alone. A tumor dose of 50 Gy (25 fractions/5 weeks) was used in postoperative irradiation, 40-60 Gy in preoperative irradiation, and 70 Gy in irradiation alone. When "number of indications," including, for example, partial pharyngectomy, positive or close (or = 5 mm) margin, and extracapsular extension, was used for multivariate analysis in patients who underwent surgery, it proved to be the only significant prognostic factor for gross survival. Six of seven patients with a positive surgical margin or close margin who received postoperative irradiation had local recurrence. A tumor dose of 50 Gy (25 fractions/5 weeks) in postoperative irradiation is not enough. It is difficult to cure by irradiation metastases to the parapharyngeal lymph nodes large enough to be detected with CT. It is necessary to irradiate parapharyngeal lymph nodes prophylactically, but 50 Gy in postoperative irradiation may not be enough from our results. The same may be true for metastases to the paratracheal nodes, which lie close to the lower poles of the thyroid gland or within the superior mediastinum and are difficult to access through surgery. In the patients who were operated on, N stage and the number of lymph node metastases were significant for gross survival. When "number of indications" was used for analysis, "number of indications" proved to be the most significant prognostic factor for gross survival.

The clinical usefulness of a new myocardial perfusion imaging agent, technetium-99m tetrofosmin, was assessed in 58 patients for a total of 76 times (mean age 9.7 years, 1-15 years) including 20 with and 26 without significant coronary stenotic lesions in Kawasaki disease. Pharmacological (dobutamine or adenosine triphosphate disodium) or exercise stress technetium-99m tetrofosmin single photon emission computed tomography was performed under stress and at rest on the same day. The sensitivity for detection of stress-induced perfusion defects by this method was 90% (18/ 20) and the specificity was 85% (22/26). The dose was 9.3 +/- 2.5 MBq/kg under stress and 18.7 +/- 5.6 MBq/kg at rest. No significant correlation was recognized between the dose and the image quality. Adequate image quality was provided by projection time 20-40 sec per frame. Increased liver accumulation was seen in 24% (18/76), especially in younger and pharmacological stress cases. The acquisition starting time after tetrofosmin injection was 58.4 +/- 18.7 min in the negative increased liver accumulation group and 43.7 +/- 18.3 min in the positive group (p0.01). We recommend that the following protocol is used for pediatric imaging. 1) The standard tetrofosmin dose is rougly 10 MBq/kg (upper limit 370 MBq) at stress and the double dose for the rest imaging. 2) SPECT projection time of 20-40 sec per frame. 3) In practice, the patient should be fasting prior to stress injection, and the imaging should be done 1 hour after eating. The rest injection should be done immediately thereafter, and the rest image should be obtained 1 hour later.

To analyze the prognostic factors for postoperative radiotherapy of metastatic brain tumors, we retrospectively analyzed the clinical records of 127 cases that received more than 30 Gy of postoperative radiotherapy. The overall one-year survival rate (SR) was 48.2%, while the intracranial control rate (ICR) was 51.7%. Univariate analysis (UVA) revealed that female sex (p = 0.02), higher radiation dose (p = 0.05), and late onset (p = 0.05) were significantly favorable factors of SR. With multivariate analysis (MVA), the approving factors were higher radiation dose (p = 0.02), small number of metastases (p = 0.004), lesser extracranial metastasis (p = 0.02), and female sex (p = 0.02). In MVA, greater radiation dose (p = 0.004), lung cancer (p = 0.02), and late onset (p = 0.05) were found to be significantly good factors for ICR. Our unique method of localized field radiation as applied to well-resected and solitary metastatic tumors, was significantly correlated with better SR in this study. As long as patients are carefully selected, this technique is though to be useful for both the reduction of late complications and dose escalation in postoperative radiotherapy.

We analyzed 52 cases of advanced or recurrent cancer of the cervix treated by intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. IAIC regimen was separated into two groups: Group I consisted of 5-FU + MMC +/- ADR (30 cases) and group II of CDDP + MMC +/- 5-FU (22 cases). The tip of the catheter was placed in the bifurcation of abdominal aorta or the bilateral internal iliac arteries (7 cases). The overall response rate (CR + PR) was 71%, 87% in patients given radiotherapy, 50% in those without radiotherapy, and 100% in primary cases. The five-year survival rate was 20% in primary cases, 14% in recurrent cases, 3% in Group I and 38% in Group II (p = 0.00182) by chemotherapy regimen. Severe (more than grade III) hematological acute side effect was 48% for all cases, but recovered by interruption of drugs. In 7 cases in which the tip of the catheter was placed in internal iliac arteries, there were severe skin ulcers in 2 cases and severe pain of leg or gluteal region requiring narcotics in 2 cases. These data suggest that IAIC mainly with cisplatin with or without radiotherapy is one of the effective treatments for advanced or recurrent cervix cancer. But we should check the blood flow distribution periodically, and control the concentration of drugs.

Twenty-two non-immunocompromised patients with primary intracranial malignant lymphomas were examined on surgical material by using an argyrophilic method for the demonstration of nucleolar organizer regions as Ag-NORs. The histopathological classifications of 22 patients included 3 small lymphocytic, 7 small cleaved, 9 large cell. 1 mixed large and small, and 2 small non-cleaved type. The numbers of Ag-NOR of malignant lymphoma patients varied from 1.36 to 5.02 (mean 3.46 +/- 0.25). The mean Ag-NOR numbers in the histopathological subtypes were small lymphocytic 1.63, small cleaved 3.18, large 4.21, mixed large and small 3.47, and small non-cleaved 3.78. The number of Ag-NORs in small lymphocytic type was significantly less than small cleaved or large cell type (p0.05). The small cleaved type also had a smaller Ag-NOR number than the large cell type (p0.05). Except for two patients who had postoperative deterioration, 20 patients received postoperative irradiation ranging from 36 to 54 Gy (median, 46 Gy). Sixteen patients had complete response to radiotherapy, and 4 had good partial response. Ten patients had tumor recurrence within the remission period of 3 months to 7 years and 10 months (median 4.8 months). Three patients with intracranial relapse at a remote site had a significantly longer remission period (mean 57.3 months) than 7 with local relapse (mean 6.29 months), p0.05. The mean Ag-NOR number of the short and long remission period were 3.13 +/- 0.34 and 3.8 +/- 0.80, respectively. No significant difference was found between these two groups. The survival period was 3.2 months to 12 years (median 20 months). The Ag-NOR numbers of survival period less than or more than 20 months were 3.62 +/- 0.40 and 3.27 +/- 0.37, respectively. The Ag-NOR numbers did not correlate with either the remission or the survival period. These results indicate that Ag-NOR numbers may correlate with the histopathologic types, but not with the prognosis of primary intracranial malignant lymphomas.

Sixty-eight hydrocephalic patients were treated with a shunt system that incorporated a SOPHY programmable valve. This device is very effective for treating disorders of CSF circulation. However, when the valve is placed on the scalp, it produces artifacts on MR imaging due to its small magnetic rotor, and may cause necrosis of the scalp above it. On the other hand, when it is positioned on the chest, MR artifacts decrease and exchanging the valve devices becomes easier. Therefore, we have positioned the device on the chest. However, some complications were encountered, such as the turning over of the valve in the subcutaneous pocket and the twisting of the shunt tube. Moreover, the shunt tube may stretch due to growth of the neck during development in infantile patients or extension of the neck during exercise. These complications are associated only with subcutaneous placement on the chest, so we conclude that such a valve, if placed on the chest, should be placed in a lower position on the chest, and if MR examination will not be performed in the foreseeable future, we recommend that it be placed on the occipital scalp, especially in infantile patients.

Surgery is an essential part of treatment for tumors of the salivary gland, yet there is increasing evidence in the literature supporting the necessity of adjuvant radiation therapy. The patients described in this report were selected to receive postoperative radiation therapy because they were found to have positive margins. We have reviewed their records to identify factors influencing the control of local disease, the development of distant metastases and overall survival, and to define the role of postoperative radiation therapy in patients with positive surgical margins.A total of 17 patients with malignant tumors originating from the major salivary glands seen between 1970 and 1988 who were treated with surgery and postoperative radiation therapy were reviewed. All patients had positive surgical margins.Overall local control at five years was 65%. Classified by T-stage, local control was obtained in all two patients for T1 disease, in five of six for T2, in four of six for T3, and in none of three for T4. At five years, the ratio of patients free of distant metastases was two of two for T1 lesion, four of six for T2, three of six for T3, and none of three for T4. Five-year survival was obtained in all eight patients with T1 and T2 lesions, four of six for T3, and one of three for T4. Patients with neck nodal metastases present in the neck at admission did worse than those with negative nodes, with 0% (none of three patients) free of locoregional recurrence vs. 71% (eleven of 14), 0% (none of three) free of distant metastases vs. 63% (nine of 14), and 0% (none of three) survival at five years vs. 93% (13 of 14).Postoperative radiation therapy for patients with positive surgical margins was effective for T1 and T2 disease. However, patients with T3 and T4 disease require more aggressive therapy. Patients with nodal metastases in the neck at admission tended to have distant metastases and had poor prognoses. Further therapeutic measures using adjuvant chemotherapy might be explored for these patients. Patients with adenoid cystic carcinoma with positive surgical margins tended to have perineural invasion and distant metastases. However, the utility of chemotherapy for patients of adenoid cystic carcinoma with distant metastases remains uncertain, because effective drugs for adenoid cystic carcinoma do not exist and patients live for several years without chemotherapy.

Although radiation therapy is the mainstay of therapy in nasopharyngeal carcinoma (NPC), the optimal dosage schemes for treating the primary tumor or cervical lymph node metastases have not been generally agreed upon. NPC is thought to be a tumor well suited to treatment with adjuvant chemotherapy because distant metastases are more common than with other head and neck sites. However, there are several reports that fail to demonstrate improved survival in chemotherapy treated patients. Careful selection of patients for chemotherapy may be required in order to show a benefit.A total of 61 patients with nasopharyngeal carcinoma seen between January, 1972 and December, 1985 who were treated with radiation therapy alone were reviewed. We analyzed the factors influencing distant metastasis and primary control.The five-year survival rate for observed and relapse-free survival were 44% and 31%, respectively. The survival rates for N3 in TNM classification and for N3 in Ho's classification were significantly worse and distant metastasis rates were significantly higher as compared with N0, N1, N2. 16 of 25 patients who had distant metastases developed them following locoregional failure. No patient with N0, N1, N2a, N2b developed distant metastases without a locoregional recurrence. There were several recurrent cases in which radiation was terminated when tumor disappeared at inspection or palpation. The five-year survival rates for T4 was 0%.The patients with N3 in TNM. Ho's classification or locoregional failure may be candidates for chemotherapy, because they have a high probability of distant metastasis. CT should be used in T staging routinely to exclude tumor involvement of the base of the skull. 70 Gy may be appropriate for T3 disease, even if tumor disappeared at lower doses. More than 70 Gy may be required to treat T4 tumors. 50 Gy may be appropriate for N0, N1 and N2b and 70 Gy for N2c and N3, even if tumor was not palpable at lower doses.

As predictors of tumor response by radiotherapy, tumor with or without c-myc amplification and DNA histogram pattern were analyzed and evaluated for patients' prognosis. There was no relation between c-myc amplification and DNA ploidy pattern in this study. These factors also showed no relation to response rate and survival. But all of the tumors with c-myc amplification and aneuploid pattern exhibited a complete response by radiotherapy. The tumors with c-myc amplification and aneuploid pattern may be more radiosensitive than without amplification and diploid. These data suggested that c-myc amplification and ploidy pattern might be a predictive parameter before radiotherapy.

Fifty patients with pineal and/or suprasellar tumors were treated in the Department of Radiology, University of Tokyo, from 1975 to 1988. Histological diagnosis was obtained in 28 cases, whereas 22 patients were irradiated without pathological verification. Of the 28 patients with histological diagnosis, 11 had germinomas, 13 non-germinoma germ cell tumors, including nine teratomas, two choriocarcinomas and two embryonal carcinomas, two pineocytomas and two pineoblastomas. The treatment protocol since 1981 has been that, after 20 Gy is given with a local irradiation field, if tumor regression is marked and germinoma is highly suspected, whole brain or whole CNS irradiation is performed subsequently; otherwise, surgical intervention is performed followed by systemic chemotherapy plus radiation therapy. The five-year survival rates of histologically proven germinomas, histologically proven non-germinoma germ cell tumors, and clinically suspected germinomas by means of the above-mentioned method as well as tumor marker status were 73%, 28%, and 83%, respectively. The overall five-year survival rate was 61.3%. A statistically significant difference was found between the survival rates for the 11 cases with histologically proven germinoma and the 13 cases with non-germinoma germ cell tumors, although there was no significant difference between the survival rates for the histologically proven germinomas and the clinically suspected germinomas. Therefore radiation therapy is an effective treatment method for the management of intracranial germ cell tumors.

From January 1975 through December 1986, 58 previously untreated patients with primary non-Hodgkin's lymphoma of the head and neck in stages I and II were treated at our department. Thirty-seven patients were classified as stage I and 21 as stage II. Complete local remission was obtained in all cases. The 5-year survival rates were 68% and 79% in stages I and II, respectively. The 5-year survival rates according to site of origin were as follows: Waldeyer's ring 77% and neck lymph node 63%. The 5-year survival rates according to the histological classification of the Working Formulation were 73% intermediate grade malignancy and 63% for high grade malignancy. Chemotherapy combined with radiotherapy was essential, especially for cases in stage II. The 5-year survival rate was 100% for patients with chemotherapy and 71% without chemotherapy. The relapse-free 5-year survival rate was 67% with chemotherapy and 36% without chemotherapy. Most first failures were due to the development of generalized disease and the 5-year survival rate after salvage was 44%.

From 1975 to 1986, 75 M0 patients with squamous cell carcinoma of the maxillary sinus were treated at the Department of Radiology, Tokyo University Hospital. The overall 5-year survival rate calculated with the Kaplan-Meier method was 24%. During the period of the study, the method of treatment used in our hospital changed. From 1975 to 1979 (the first period), the treatment of choice was low-dose irradiation and frequent necrotomy. From 1980 to 1982 (the second period), more extensive surgery was performed and 50 to 60 Gy of irradiation was given. The 5-year survival in the first period was 20%, that in the second 14%. From 1983 to 1986 (the third period), trimodal therapy (surgery + radiation + intra-arterial infusion) was introduced and 5-year survival was improved to 50%. Intra-arterial cisplatinum infusion and treatment planning using CT scans were especially useful in improving survival.

Retrospective analysis of patients with refractory tumors which were treated with hyperthermia alone in five institutions was performed. Hyperthermia was applied to 30 refractory tumors including 19 deep-seated tumors for a total of 427 sessions by 8 MHz or 13.56 MHz radiofrequency capacitive heating devices. Of the 30 tumors treated, 3 (10%) showed complete regression and 2 (7%) more than 50% regression. Although tumor regression was observed in small tumors, large deep-seated tumors did not respond to heat alone. Thus, response rate of hyperthermia alone was lower than expected, although subjective improvement by hyperthermia was noted in 53% patients. We consider that hyperthermia should be combined with radiation or chemotherapy whenever possible.

Twenty cases of metastatic bone tumors were treated with Elcatonin together with irradiation, achieving pain relief in 47.3% of cases, improved bone scintigrams in 16.7% of cases and radiographic improvement of invaded bone in 7.7% of cases. It has reported that calcitonin is effective for pain relief in 50% of cases but for the radiographic improvement of bone lesions in only 0-10%. The life quality of patients with bone metastases is controversial since treatment techniques for advanced oncological patients has progressed remarkably. The pain relief obtained with calcitonin contributes significantly to improving the quality of life for such patients when administered in combination with conventional treatment modes.

Forty consecutive cases of carcinoma of the oropharynx were treated by irradiation from 1973 through 1987. The overall five-year survival rate calculated by the Kaplan-Meier method was 21%. Data were also analyzed retrospectively to investigate the factors associated with prognosis. The following results were obtained. (1) The results of re-irradiation as salvage treatment were poor. (2) Irradiation to neck lymph node metastases was not particularly effective, especially under 50 Gy. (3) Stage T2(-4) primary tumors were difficult to control with irradiation of 50 Gy.

Radiation therapy has now an increasing role in the treatment of rectal cancer. Formerly it was used for the palliation of recurrent or residual tumors, but now it is more frequently used for preoperative purposes. Preoperative radiotherapy has the following advantages. It often makes unresectable tumors resectable, prevents tumor seeding during the operation, treats the lateral involvement by the tumor, and makes resectable tumors resected more conservatively. So far we've treated 22 patients with advanced stage rectal cancer by preoperative radiotherapy. Their 3 year local control rate and survival rate was 79% and 86%, respectively, with 9% complication rate. And as for the anal cancers preoperative irradiation and more conservatively, definitive irradiation with doses more than 60 Gy are quite worthwhile both in terms of local control and complication. Both for rectal and anal cancers radiotherapy seems quite promising modality in local tumor control and the patient's quality of life. Further clinical trials are necessary.