A retrospective review of 325 patients was undertaken to analyse whether involvement of the radial resection margin (RRM) could predict locally recurrent disease or distant metastases in patients who had curative surgery for rectal or rectosigmoid cancer. Information on the RRM was available in 253 patients. The RRM was involved in 31 (12 per cent). Nine of these 31 patients developed local recurrence (29 per cent), while only 17 local recurrences were diagnosed in 217 patients (8 per cent) without involvement of the RRM (P < 0.01). At 2 years the overall local recurrence rate was 10 per cent. Distant metastases were diagnosed in 46 patients (18 per cent) and RRM involvement was identified as a prognostic factor depending on lymph node involvement (N stage) (P = 0.02). Local recurrence and some distant metastases result from microscopically incomplete resection. Assessment of the radial depth of tumour invasion by careful histological examination of x791p4ecimen may be used for selection of patients for adjuvant radiotherapy and/or chemotherapy.

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The limited number of patients available for analysis, methodological flaws and a significant over-representation of patients with FIGO stage IIIB prohibit drawing definite conclusions regarding the impact of adding hyperthermia to standard radiotherapy. However, available data do suggest that the addition of hyperthermia improves local tumour control and overall survival in patients with locally advanced cervical carcinoma without affecting treatment related grade 3 to 4 acute or late toxicity.

Purpose: To determine the accuracy of conventional computed tomography (CT) scan in the preoperative prediction of an involved circumferential resection margin (CRM) in primary rectal cancer. Methods: 125 patients with biopsy-proven adenocarcinoma of the rectum underwent CT of the abdomen before undergoing total mesorectal excision. Scans were scored by three observers, differing in experience. The main outcome was yes/no involvement of the CRM. Histology was taken as reference standard. Results: For the most experienced observer, observer A, sensitivity was 46.7% and specificity 92.6%. For observer B, sensitivity was 46.7% and specificity 89.5%. For the least experienced observer C, sensitivity was 43.3% and specificity 92.6%. Inter-observer variability was good between observers A and B (ĸ 0.648), B and C (ĸ 0.648), and intermediate between A and C (ĸ 0.542). Discrepancies occurred in a total of 34 patients; 25 had a CT scan of low technical quality, 10 an anteriorly located distal tumor. Conclusion: Conventional CT scan lacks sensitivity for a clinical use in the preoperative assessment of an involved CRM in primary rectal cancer. Modern multislice spiral CT will probably resolve some of the problems of conventional CT; however, further research is needed to establish its role.