Conservative and curative management of rectal adenocarcinomas by local radiotherapy alone

Two hundred patients with well-differentiated adenocarcinomas of the rectum stages T1, T2 (113 T1, 87 T2) were accrued in two French institutions (Lyon-Sud and Dijon). Treatment consisted of intracavitary 50 kV X-rays (90-120 Gy in 3-4 fractions and 4-6 weeks). A 20-30 Gy interstitial brachytherapy boost was given after 2-3 fractions when a limited infiltration of the rectal wall was present. Local failure occurred in 4.4% of T1, 19.5% of T2; nodal failure in 0.9% of T1, 9.2% of T2. Ultimate local control after salvage of failures is 94.5%. A functional sphincter was preserved in 95% of patients with local control.