A retrospective comparison of transanal surgery and endocavitary radiation for the treatment of 'early' rectal adenocarcinoma

D. B. Frost, R. Wong and A. Rao
Division of Surgical Oncology, Kaiser Permanente Southern California Medical Group, Los Angeles.

OBJECTIVE: To compare two techniques for the local treatment of "early" rectal adenocarcinoma. DESIGN AND STUDY PARTICIPANTS: A retrospective comparison of 27 patients who underwent transanal disk excision and fulguration (group A) and 38 patients who underwent transanal endocavitary radiation (group B). SETTING: Inpatient and outpatient. INTERVENTION: Group A patients had rectal adenocarcinoma treated with disk excision and fulguration. Group B patients received 100 to 125 Gy in four to five fractions using the Phillips RT-50 unit. MAIN OUTCOME MEASURES: Survival and local recurrence. RESULTS: The median follow-up for group A was 68 months; for group B, 38 months. The mean tumor diameter was 2.5 cm, all were grade 1 or 2. The local recurrence rate was 7.4% for group A and 21% for group B. Local recurrence was not correlated with tumor grade, location, or size but did correlate with tumor ulceration. CONCLUSION: For selected early rectal cancers, surgical excision and fulguration offers better local control than endocavitary radiation therapy, while survival was similar.