A phase I trial of preoperative radiation, proctectomy, and endoanal reconstruction
A. M. Cohen and B. D. Minsky
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
The purpose of this study was to explore the feasibility of sphincter
preservation in abdominoperineal resection candidates by combining
high-dose preoperative radiation therapy with restorative proctectomy
through an endoanal anastomosis. Radiation to the pelvis was given using a
three- or four-field technique to 4680 cGy (180 cGy/d) with portals from
the top of S1 to 2 cm below the anus. The tumor bed received an additional
360-cGy boost. Four to 6 weeks after radiation therapy was completed, the
patients underwent radical surgery. Phase I results for 14 patients are
presented. All surgical specimens had negative distal and lateral margins.
Surgical complications included one small-bowel obstruction requiring
reoperation at 3 weeks, one pulmonary embolism, and one partial disruption
(30% of the circumference) of the anastomosis. Bowel control and function
were excellent in 8 and good in 4 patients. Function was not yet assessable
in the remaining 2 patients.
