Conservative treatment of carcinoma of the anorectal region--the role of radiation therapy

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.