Preoperative radiation and chemotherapy for anal and rectal cancer

It became apparent on review of the recent literature that the combination of radiation therapy and chemotherapy may offer increased response in patients wih locally advanced carcinomas of the anus and rectum. The protocol for this group is 1 week of chemotherapy with 3 weeks or radiation, followed by 3 to 6 weeks later by surgical intervention. In this limited group of 10 patients, considerable benefit was noted. All of the lesions decreased dramatically in size, with 8 of the 10 patients showing more than a 50 percent decrease. Only 1 of the 10 patients showed evidence of nodal involvement at the time of surgery. Three of the patients showed no evidence of tumor and three others showed microscopic tumor only. While the number of patients is small and follow-up is still short, the study seems to have shown the same improved results which have been reported by others using similar protocols. If our long-term follow-up remains equally satisfactory, then the concept of low dose drug therapy combined with radiation could have broader implications, and perhaps be extended to other neoplastic diseases with the same excellent tolerance. This form of therapy can be provided in the setting of a community cancer center, where radiation therapy and medical oncology services are available as an adjunct to surgery.