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Speciality
Spotlight

   




 

Radiology

 

    




Radiotherapy
and Rectal Cancer -
The Present Position

   

  • R.D.
    James



    Radiotherapy and Rectal Cancer – The Present Position


    Recent Advances in Surgery, Number 22, Year -1999,
    Pg.109

       


    The differential effect of XRT is largely due to the
    ability of normal tissues to repair more nuclear
    damage than malignant tissues. XRT is used for
    cancers of the bladder, prostate and uterus as well
    as the rectum.

       


    Permanent sterility is inevitable. Acute XRT induced
    enteritis appears approximately 2 weeks after the
    start of XRT. Late XRT-enterities may require
    extensive surgery for obstruction, bleeding, and
    fistula formation.

         


    The need of XRT is probably better determined by
    lateral resection margin [LRM] positivity and the
    need for adjuvant chemotherapy by lymph node
    positivity.

          


    A cure rate of at least 80% has been reported by
    most series for so-called contact XRT alone for
    tumours of less than 5 cm in diameter. Contact XRT
    differs from conventional XRT by delivering an
    extremely high [100-120 Gy] tumour surface dose in 3
    or 4 treatments of 5 minutes over at least 2 months.

        


    Conservative surgery for larger tumours is safer
    following pre-operative XRT.

        


    Largest [80%] group of patients with rectal cancer
    are suitable for radical surgery with a view to cure
    both pre-operative and postoperative XRT reduce
    local recurrence by 30-50%.

         


    Toxicity was worse for post-operative than for
    pre-operative XRT.

          

  • U Chetty, W. Jack, R.J. Prescott, C. Tyler and A. Rodger, on behalf of the Edinburgh Breast Unit [ Correspondence to : Mr. U. Chetty, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK]

    Management of the Axilla in Operable Breast Cancer Treated by Breast Conservation : a Randomized Clinical Trial

    Br. J. of Sur. Volume 87, Number 2, February, 2000, Pg. 163

       

    In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately.

      

    Patients with operable breast cancer were randomized to have level III axillary node clearance. Radiotherapy [RT] to the axilla was given selectively. RT was not given to those who had an axillary clearance. The first 54 patients were subjected to node sampling and RT. Subsequently only node positive patients were given RT. The morbidity,
    upper limb volume, and circumference, and glenohumeral and scapular movements were assessed.

      

    No difference was found in local axillary or distant recurrence. There was no statistical difference in the 5-year survival ratio. The morbidity was least in those who had node sampling but no RT, to axilla. RT to axilla who had a node sample resulted in a significant reduction in range of movement of the shoulder. Surgical axillary clearance was associated with significant lymphoedema of the upper extremity.

          

   



 

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Speciality Spotlight

   

 
Radiology
 

    

Radiotherapy and Rectal Cancer - The Present Position
   

  • R.D. James
    Radiotherapy and Rectal Cancer – The Present Position
    Recent Advances in Surgery, Number 22, Year -1999, Pg.109
       
    The differential effect of XRT is largely due to the ability of normal tissues to repair more nuclear damage than malignant tissues. XRT is used for cancers of the bladder, prostate and uterus as well as the rectum.
       
    Permanent sterility is inevitable. Acute XRT induced enteritis appears approximately 2 weeks after the start of XRT. Late XRT-enterities may require extensive surgery for obstruction, bleeding, and fistula formation.
         
    The need of XRT is probably better determined by lateral resection margin [LRM] positivity and the need for adjuvant chemotherapy by lymph node positivity.
          
    A cure rate of at least 80% has been reported by most series for so-called contact XRT alone for tumours of less than 5 cm in diameter. Contact XRT differs from conventional XRT by delivering an extremely high [100-120 Gy] tumour surface dose in 3 or 4 treatments of 5 minutes over at least 2 months.
        
    Conservative surgery for larger tumours is safer following pre-operative XRT.
        
    Largest [80%] group of patients with rectal cancer are suitable for radical surgery with a view to cure both pre-operative and postoperative XRT reduce local recurrence by 30-50%.
         
    Toxicity was worse for post-operative than for pre-operative XRT.
          

  • U Chetty, W. Jack, R.J. Prescott, C. Tyler and A. Rodger, on behalf of the Edinburgh Breast Unit [ Correspondence to : Mr. U. Chetty, Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK]
    Management of the Axilla in Operable Breast Cancer Treated by Breast Conservation : a Randomized Clinical Trial
    Br. J. of Sur. Volume 87, Number 2, February, 2000, Pg. 163
       
    In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately.
      
    Patients with operable breast cancer were randomized to have level III axillary node clearance. Radiotherapy [RT] to the axilla was given selectively. RT was not given to those who had an axillary clearance. The first 54 patients were subjected to node sampling and RT. Subsequently only node positive patients were given RT. The morbidity, upper limb volume, and circumference, and glenohumeral and scapular movements were assessed.
      
    No difference was found in local axillary or distant recurrence. There was no statistical difference in the 5-year survival ratio. The morbidity was least in those who had node sampling but no RT, to axilla. RT to axilla who had a node sample resulted in a significant reduction in range of movement of the shoulder. Surgical axillary clearance was associated with significant lymphoedema of the upper extremity.