Journal of Medical Physics
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Year : 2000  |  Volume : 25  |  Issue : 2  |  Page : 72-74

Carcinoma Anorectum - Preliminary Experience With External Radiotherapy Combined With Intraluminal Brachytherapy

Correspondence Address:
Neeraj Jain

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A uniform treatment policy for carcinoma anal canal and lower third of rectum is difficult to define for various reasons. The present approach is to take into consideration the psychological impact of the colostomy and preserve anatomy and function without compromising on the results. Concomitant radiotherapy and chemotherapy is given now-a-days as an alternative to surgery. External radiotherapy (RT) alone can control early and intermediate disease, but produce serious side effects. Brachytherapy, because of its rapid fall off of dose, enables to deliver high local dose. From 1990 to 1997, we have treated 19 patients of anorectal cancer with external RT and intraluminal brachytherapy. Till 1994, the policy was to give high fraction dose with brachytherapy. 10 patents ere treated during this period and brchytherapy dose was 10-12 Gy/fraction. Radiotherapy was given to total dose of 60-65, Gy. Since the tolerance of the patients was poor with this dose, we changed the policy after 1994 and reduced the dose per fraction to 5-6 Gy/fraction by brachytherapy. Total fractions given were 2-3 depending upon dose received with external RT. 9 patients were treated during this period. Brachytherapy was given with Selectron remote afterloading system. At an approximate dose rate of 500-600 cGy/h. Dose was calculated at 5 cm from surface and 1.5-2 cm from the centre of the applicator. The patients who were followed for 6 months were assessed. In the first group (1 990-1 994). out of the 10 patients treated, 3 were lost for follow-up, 2 had complete response earlier but the disease recurred after 1 year. 5 had partial response for which APR was done in 3 patients and palliative colostomy in 2. Overall results were poor. In the 2nd group (1995-1997), out of the 9 patients treated, 1 was lost for follow-up and 8 had complete response., 1 out of these had local recurrence at 1 year and was advised APR. Complications were high in group 1 with a patient having rectal ulceration and 1, rectovesical fistula. In group 2, only 1 patient had stricture formation.

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