Rectal and Anal Cancers: Conservative Treatment by Irradiation -- An Alternative to Radical Surgery

ISBN-13: 9783642686153 / Angielski / Miękka / 2011 / 204 str.

J. Papillon; O. H. Beahrs

Opis

Although attempts at radical removal of cancers of the rectum had been performed earlier, it was not until W. E. Miles in 1908 re ported his experience in the management of cancer in this ana tomic part, that the combined abdominoperineal resection be came the recognized and accepted approach for the treatment of this cancer. Miles reasoned that proctectomy removed the cancer, bearing a segment oflarge bowel but also the regional lymphatics into which the cancer spread, not only proximally, but laterally and distally as well. In his monograph in 1926 he stated: . . . There are, I hold, two main principles to be observed in the surgical treatment of cancer of the rectum and indeed of all cancers wherever they are found, first, ope ration should be based on a knowledge of the demonstrable facts of pathology, and, second, the most extensive operation possible in conformity with that knowl edge should be performed on all patients no matter how small or early the local manifestation of the disease may seem to be . . . This philosophy was appropriate in his time but today, with increased knowledge regarding the biological behavior of cancer of the rectum, the recognition of the importance of the extent of the primary lesion and staging of cancer, and the availability of multiple modalities in the management of neoplastic disease, the philosophy has appropriately changed."

Spis treści

Section A. Carcinoma of the Rectum.- I. General Considerations.- 1. Age and Sex Distribution.- 2. Topographical Distribution.- 3. Stage Distribution.- II. Pathology.- 1. Histology.- 2. Natural History.- 3. Spread of Rectal Cancer.- a) Local.- b) Lymphatic.- c) Venous.- d) Distant Metastases.- 4. Staging.- III. Surgical Treatment.- 1. Criteria Governing Choice of Procedure.- 2. Surgical Results.- a) Operative Mortality.- b) Sequelae of Surgery.- 3. Additional Therapy.- a) Pre-operative Irradiation.- b) Pre-operative Chemotherapy and Radiotherapy Combined.- c) Post-operative Irradiation.- IV. Rationale of Conservative Treatment for Cure.- 1. Selection of Suitable Cases.- a) Risk of Lymphatic Spread.- b) Site of Tumour.- c) Status of Patient.- 2. Proper Schedules for Treatment.- 3. Follow-up.- 4. Modalities of Conservative Treatment for Rectal Cancer.- V. Conservative Treatment by Surgery.- 1. Local Excision.- 2. Electrocoagulation.- a) Results.- 3. Cryosurgery.- VI. Conservative Treatment by Irradiation.- 1. Historical Background.- 2. External Beam Irradiation.- 3. Intracavitary Irradiation of Rectal Tumours.- a) Contact X-ray Therapy.- b) Interstitial Curietherapy.- c) Development of Intracavitary Irradiation.- d) Experience at the Centre Léon Bérard (Papillon).- e) Problem of Rectal Adenocarcinomas of the Juxta-anal Area.- f) Indications.- VII. Comparison of Surgical and Radiotherapeutic Methods of Local Therapy.- 1. Mode of Action.- 2. Conditions of Application.- 3. Control of Tumour.- 4. Follow-up.- 5. Conclusion.- VIII. Intracavitary Irradiation as a Supplementary Procedure After Local Excision — Problem of Villous Adenomas.- 1. Experience at the Centre Léon Bérard.- Section B. Epidermoid Carcinoma of the Anus.- Topographical Distribution of Anal Cancers.- IX. Epidermoid Carcinoma of the Anal Canal.- 1. Introduction.- 2. Anatomical and Pathological Background.- X. General Features.- 1. Frequency and Sex Distribution.- 2. Age.- 3. Site.- 4. Configuration.- 5. Tumour Spread.- a) Local Spread.- b) Regional Spread.- c) Distant Spread.- 6. Symptoms and Diagnosis.- 7. Pre-treatment Evaluation.- 8. Clinical Staging.- XI. Treatment.- 1. Surgery.- a) Local Excision.- b) Major Surgery.- c) Extended Surgery.- d) Colostomy.- 2. Radiation Therapy.- a) Historical Background.- b) Interstitial Curietherapy.- c) External Beam Irradiation with Cobalt-60.- d) Complications of Irradiation.- XII. New Therapeutic Approaches.- 1. Background.- a) Accessibility.- b) Radiosensitivity.- c) Radionecrosis.- d) Time Factor.- e) Multimodality Treatment.- 2. Recent Developments.- a) Pre-operative Irradiation With or Without Chemotherapy.- b) Split-course Irradiation.- XIII. Experience at the Centre Léon Bérard.- 1. First Protocol — Association of Cobalt-60 and Iridium-192 Implant in a Split Course.- 2. Second Protocol — Irradiation Followed by Radical Surgery.- 3. Third Protocol — Whole-pelvic and Anal Irradiation.- 4. Results.- a) Curative Irradiation with Cobalt-60 and Iridium-192.- b) Pre-operative Irradiation and Radical Surgery.- c) Whole-pelvic Irradiation for Unresectable Tumours.- 5. Lymphatic Spread.- a) Inguinal Metastasis.- b) Pelvic Node Metastasis.- XIV. Indications for Treatment.- 1. Management of Tumours of the Anal Canal.- 2. Management of Lymph Node Metastasis.- a) Inguinal Lymph Nodes.- b) Pelvic Lymph Nodes.- XV. Epidermoid Carcinoma of the Anal Margin.- 1. General Features.- 2. Local Spread.- 3. Clinical Staging.- 4. Treatment.- a) Local Excision.- b) Irradiation.- 5. Indications.- a) Treatment of Tumours of the Anal Margin.- b) Treatment of Inguinal Nodes.- XVI. Conclusion.- XVII. References.- A. Cancer of the Rectum.- B. Cancer of the Anus.- XVIII. Subject Index.- A. Cancer of the Rectum.- B. Cancer of the Anus.