ORLANDOThere are still too many rectums being removed in
patients with invasive rectal cancer, said W. Robert L. Rout,
MD, associate professor of surgery, University of Florida,
Gainesville. He believes this situation could be improved with the
use of preoperative radiotherapy and chemotherapy.
A number of surgeons do not use preoperative radiation therapy
for rectal cancer, even though it can save the rectum and spare the
patient from the need for a colostomy, Dr. Rout said at the
Joint Cancer Conference of the Florida Universities. And for
most patients, preoperative radiation therapy and chemotherapy also
Dr. Rout stressed the collaborative nature of the cancer care given
at his institution, which contributes to their success rates.
Our surgeons work on a team with the radiation oncologists and
with the medical oncologists to provide the maximum benefit to
patients. Being a tertiary care center, he said, his
institution sees a population that includes a lot of patients
that others have given up on.
He described the radiation treatment regimen used at the University
of Florida: For tumors that are early, movable, not ulcerated and
thought to be T2 or T3, patients receive 50.4 Gy as the total
preoperative tumor dose. The treatment is given in 28 daily fractions
with a boost at the end.
The radiologists target fields that include the primary tumor volume
and the draining lymphatic vessels, including the internal/external
iliac system and the distal common iliac. The boost covers the sacrum
coccygeal area as well as the tumor volume.
All patients also receive continuous circadian rhythm chemotherapy
with fluorouracil, 225 mg/m²/d, plus leucovorin, 20 mg/m²/d,
administered via a programmable infusion pump.
With such pretreatment, tumors often shrink dramatically, Dr. Rout
said. Often when we operate on these patients, we find no tumor
remaining, so we just cut out the scar. Or there may be a small tumor
left, a T1 or T2 grade tumor.