The Role of Radiation Therapy in the Management of Carcinoma of the Sigmoid, Rectosigmoid, and Rectum

Cancer of the colon is one of the more frequent types of cancer in man. Carcinomas of the sigmoid, rectosigmoid, and rectum account for approximately two-thirds of all such cancers (1). These tumors are almost always adenocarcinomas of varying degrees of differentiation. In contrast to adenocarcinomas elsewhere in the gastrointestinal tract, the prognosis, especially in early cases, is quite favorable; favorable enough, indeed, to place this tumor in the category of so-called curable cancer, along with cancer of the cervix, larynx, breast, lip, and a few others. Cure is accomplished by surgical removal. There are, however, a considerable number of patients whose lesions are unresectable because of local or distant spread of the disease. It is obvious, therefore, that a search for any therapeutic means which might benefit this group is more than justified. Under certain circumstances some of the tumors and their local spread in the pelvis are quite amenable to vigorous radiation therapy (2–6). From 1940 to 1960 inclusive, 111 cases of cancer of the sigmoid, rectosigmoid, and rectum were seen and treated by radiation therapy in the Department of Radiology of the Massachusetts General Hospital. The records of these cases were carefully reviewed and the information obtained forms the basis of the present paper. General Clinical Data Of the 111 patients (Table I) with cancer of the sigmoid, rectosigmoid, and rectum, 86 had recurrences following radical surgery, 16 had lesions inoperable because of local or distant spread of the disease, and 9 had obvious residual cancer in the pelvis following radical or palliative resection. Fifty-nine were males and 52 were females. There were no patients below twenty years of age. It is of interest that 16 patients, or approximately 14 per cent of the entire group, were in the twenty- to thirty-nine-year age group, and 84 patients, or 75 per cent, were fifty or over. Anatomically the lesions were distributed as follows: 81 in the rectum; 15 in the rectosigmoid; 15 in the sigmoid. All were histologically verified as adenocarcinoma of varying degrees of malignancy. Among the commonest symptoms and signs of reactivation in cancer of the sigmoid, rectosigmoid, and rectum were pain, a recurrent mass, bleeding, and discharge. The pain was generally a dull aching deep inside the pelvis and in the perineal region with occasional radiation to both legs. Recurrent masses could be felt either through the abdominal wall or through the perineum, and in female patients on pelvic examination. Bleeding was not uncommon in females in whom the tumor had invaded the cervix and vagina and was generally accompanied by foul discharge. Of the 86 patients who had recurrences following radical surgery, 52 or 60 per cent presented symptoms and signs of recurrent disease in less than two years (Table II). In slightly less than one-third of the patients the interval was less than twelve months.