The University of Missouri-Columbia protocol for localised
cancer of the prostate calls for pelvic node dissection, 10000 cGy at the periphery of the prostate from 125I and 4000 cGy in 20 fractions to the whole pelvis using supervoltage
X-ray therapy. Rectal complications were studied in 104 patients; acute and chronic reactions were defined. During external irradiation 54% did not develop diarrhoea, 43% had mild diarrhoea and 3% had severe diarrhoea. In the chronic stage 77% did not have diarrhoea, 12% had delayed, non-distressing rectal
bleeding which did not need specific treatment or needed only simple treatment, 7% had prolonged distressing
proctitis and 4% had rectal ulceration or recto-urethral
fistula necessitating
colostomy. Each of the four patients who had
colostomy had an additional aetiological factor (arterial disease, pelvic
inflammation, additional radiation, pelvic
malignancy or second operation). None of the patients entered in the combined
brachytherapy and teletherapy programme, and in whom 0.5 cm space was maintained between the closest seed and the rectal mucosa, developed prolonged
proctitis.