A surgeon looks at radiotherapy in cancer of the colon and rectum.

T MAY SEEM ODD THAT A SURGEON HAS CHOSEN I to speak to you on the subject of radiotherapy in the management of cancer of the colon and rectum. I certainly profess no knowledge of (.lie finer points of ionizing irradiation or radiobiology, but I would like to rise to the occasion nevertheless and give you my point of view on this interesting topic. It is obligatory as well as interesting because the multidisciplinary attack on cancer is here to stay, as evidenced by this joint meeting, and because the Rectum and Colon Service of the Memorial Hospital, N.Y.C., has played a role in developing such an attack. the 200-250 kv machine and/or the insertion of radium tampon or irradiated gold seeds. For the small tumors, he reported a series of 17 of 18 patients living 5 years or more following treatment.‘ For the advanced inoperable tumor, he described 43y0 good palliative results, 29% moderate palliative results, and 19% mild palliative results.6 This was an astonishingly good achievement in over 200 selected patients reported a t that time. I will discuss here the current management of cancer of the colon and rectum with ionizing irradiation under three headlines: preoperative irradiation, curative irradiation, and palliative irradiation. HISTORICAL PREOPERATIVE IRRADIATION In briefly tracing the historical development of ionizing irradiation in the treatment of cancer of the rectum, there were many reasons why this mode of therapy had been tried in the 1920’s and 1930’s, when the Miles procedure or abdominoperineal resection carried a formidable operative mortality. This was before the refinements of surgical technique, improked anesthesia, better preand postoperative care, and antibiotic therapy. The low position of rectal cancer made i t accessible to the application or administration of ionizing irradiation. Radiotherapy had also been proven to be efficacious in the management of other cancers, particularly of the cervix, endometrium, etc. Binkley, the first Chief of the Colon and Rectum Service at Memorial Hospital, described the selective use of ionizing irradiation in the treatment of cancer of the rectum both for cure in poor risk patients, and palliation in advanced inoperable cases over 40 years a g ~ . ~ . ~ The sources of irradiation included external irradiation by the radium pack, or