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November 15, 1976

Treatment of Colorectal Cancer-Reply

JAMA. 1976;236(20):2284-2285. doi:10.1001/jama.1976.03270210016004

Dr Gamero argues that, unlike surgery, radiotherapy "has increasingly improved results" in colorectal cancer that are "clearly demonstrated" in the articles to which he refers. Unfortunately, Dr Gamero's enthusiasm with radiotherapy is neither shared by the authors of the articles that he quotes nor by those that he apparently overlooked.

One must evaluate the role of radiotherapy in the right perspective of its scope of therapeutic achievement. One should first bear in mind that radiotherapy has been given primarily to patients with rectal or rectosigmoid lesions, which comprise approximately 40% of all colorectal cancer cases.1 Thus, if there is any beneficial effect on prognosis, it is limited to a fraction of the patients. This dilutes the overall effect.

Second, and even more important, colorectal cancer, like breast cancer, is not a local disease but a disease that tends to be disseminated (micrometastases) already at the time of