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Definitive radiation therapy for selected cancers of the rectum

During the last 15 years, over 400 patients with adenocarcinoma of the rectum have undergone a course of endocavitary irradiation for cure or palliation of Dukes' A and B disease. This treatment method makes use of an unconventional fractionation scheme, by which the tumour receives 10000–12000 cGy in approximately four fractions over a period of about 60 days. The treatments are separated by an interval of 2 or 3 weeks. This method of definitive irradiation allows suitable patients to avoid abdominoperineal resection and its drawbacks. Hospitalization is avoided and the patients maintain a normal daily life. Approximately 15–20 per cent of all rectal cancer patients may be expected to fulfil the criteria for selection, which are sufficiently strict that the local control (95 per cent) and 5‐year survival rates (94 per cent) can exceed those of surgery for comparable disease.