Long-term follow-up of local excision and radiation therapy for invasive XXXX .

@entity1 @entity5 @entity188 @entity3 @entity204 @entity420
PURPOSE: Little is known regarding the long-term outcome of @entity1 with @entity5 treated by local excision and radiation therapy. We updated our institutional experience with this approach. METHODS: From January 1986 to December 1991, 23 @entity1 (median age, 64 (range, 30-80) years) with mobile, moderately differentiated @entity188 were offered transanal excision. Two @entity1 with large T3 @entity5 , who were judged intraoperatively to be unsuited for a local procedure, received radical resection and were excluded from analysis. Twenty-one @entity1 underwent transanal excision en bloc (14) or piece-meal (7) through a resectoscope. Seven @entity1 (74 percent) had either extensive medical problems or refused a colostomy. @entity1 received a median of 5,040 cGy postoperatively, and 15 also received 500 cGy preoperatively on protocol. Two @entity1 received concomitant chemotherapy. Median follow-up is 56 months for all @entity1 and 67 months for survivors (range, 27-92 months). RESULTS: There were 2 T1, 15 T2, and 4 T3 @entity5 . The distance from the anal verge was a median of 4 (range, 1-7) cm. The median @entity5 size was 3 (range, 2-7) cm. Sixteen @entity1 had more than one-third of the wall involved. Four @entity1 (19 percent) developed a local recurrence at 26, 30, 33, and 48 (median, 31.5) months. Three were salvaged (abdominoperineal resection = 2; low anterior resection = 1) and remain disease-free 18, 36, and 37 months postoperatively. Four @entity1 (19 percent) developed @entity3 (lung = 3; liver = 1) at 3, 22, 25 and 44 months after initial treatment (median, 23.5 months). The actuarial five-year overall, disease-free and recurrence-free survival are 77, 75, and 58 percent, respectively. Twelve @entity1 (57 percent) have no evidence of disease while retaining their rectum. There was one @entity204 . CONCLUSIONS: Long-term follow-up confirms that local excision and radiation therapy is of value in @entity1 with mobile @entity5 of the rectum. It suggests that this treatment can be offered to those @entity1 who refuse a colostomy or are medically compromised and may be an acceptable option for selected @entity1 with T2 or T3, mobile @entity420 of the rectum.
