Preoperative irradiation and 5-fluorouracil suppository for carcinoma of the rectum.

For prevention of local recurrence of rectal carcinoma postoperatively, we attempted to use preoperative irradiation, 5-fluorouracil suppository, or both. When 5-fluorouracil was employed, it produced a remarkably high drug concentration in the rectum and regional lymph nodes. 5-fluorouracil suppository alone did not increase the 5 year postoperative survival rate. Preoperative irradiation combined with 5-fluorouracil suppository (combined treatment group) produced shrinkage of tumor size in 18 of 23 patients, including tumor disappearance in 2 patients, whereas irradiation alone produced shrinkage of tumor size in 13 of 24 patients. Cancer invasions to the external wall of the rectum and lymph node metastases, which were the most influential factors on local rectal recurrence postoperatively, were significantly reduced by preoperative combined treatment.