Rectal and Anal Cancers : Conservative Treatment by Irradiation — an Alternative to Radical Surgery

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. Although attempts at radical removal of cancers of the rectum had been performed earlier, it was not until W.E. Miles in 1908 reƯ ported his experience in the management of cancer in this anaƯ tomic part, that the combined abdominoperineal resection beƯ 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, opeƯ ration should be based on a knowledge of the demonstrable facts of pathology, and, second, the most extensive operation possible in conformity with that knowlƯ 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 Front Matter....Pages I-XVI Introduction....Pages 1-2 Front Matter....Pages 3-3 General Considerations....Pages 5-7 Pathology....Pages 8-18 Surgical Treatment....Pages 19-38 Rationale of Conservative Treatment for Cure....Pages 39-52 Conservative Treatment by Surgery....Pages 53-62 Conservative Treatment by Irradiation....Pages 63-99 Comparison of Surgical and Radiotherapeutic Methods of Local Therapy....Pages 100-103 Intracavitary Irradiation as a Supplementary Procedure After Local Excision — Problem of Villous Adenomas....Pages 104-105 Front Matter....Pages 107-107 Topographical Distribution of Anal Cancers....Pages 109-109 Epidermoid Carcinoma of the Anal Canal....Pages 110-113 General Features....Pages 114-125 Treatment....Pages 126-137 New Therapeutic Approaches....Pages 138-144 Experience at the Centre Léon Bérard....Pages 145-170 Indications for Treatment....Pages 171-177 Epidermoid Carcinoma of the Anal Margin....Pages 178-185 Conclusion....Pages 186-188 References....Pages 189-198 Back Matter....Pages 199-204