suitably selected group of patients. It seems possible that these are the same patients who are most likely to benefit from abdominoperineal resection. Many patients, I believe, would be willing to take part in a clinical trial to compare the two modes of treatment. I do not minimize the difficulties, but having coordinated a clinical trial comparing a policy of radical radiotherapy with one of surgery at another cancer site, I believe these problems are soluble and that a good case has been presented by the opposing parties for instituting such a trial. The subcommittee on clinical trials of the Cancer Research Coordinating Committee (composed of representatives of the Medical Research Council, Health and Welfare Canada, the National Cancer Institute of Canada, and the Ontario Cancer Treatment and Research Foundation) have set up a working group to consider clinical trials in the treatment of gastrointestinal malignant disease. As secretary of the subcommittee and the working group, I welcome communication from surgeons and radiotherapists throughout the country who are willing to participate in a clinical trial designed to resolve the question. Patients will be those who are clinically assessed as having operable conditions and being fit for radical radiotherapy and who agree to be included in the trial. Primary treatment will be given after randomization but if subsequent circumstances that arose were to dictate the alternative treatment, then this could be given. Hence, postoperative radiotherapy would not be excluded in the presence of clinical indications in the surgically treated group, nor would postradiation surgery be excluded if indications for it arose in the radiotherapy-treated group. In a number of instances oncologists in Canada have shown themselves ready to abandon prejudice and evaluate different forms of therapy in appropriate controlled trials. The mechanism for coordinating those trials is well established, and the ethical issues have been faced and largely solved. I believe that Canadian medicine could make a substantial contribution to world knowledge by taking a leadership role in this area. A.B. MILLER, MB, FRCP[C] Director. epidemiolo.y unit National Cancer Institute of Canada University of Toronto Toronto, Ont.

Reference 1. RIDER wD: The 1975 Gordon Richards Memorial Lecture: Is the Miles operation really necessary for the treatment of rectal cancer? J Can Assoc Radiol 26: 167, 1975

To the editor: Dr. W.D. Rider's Gordon Richards Memorial Lecture,1 in

which he argued that radiotherapy is the treatment of choice for cancer of the lower rectum, was unexpected. We believe he has overstated his case in places, but that he has at least raised the possibility of a much less mutilating treatment, which may give a cure rate comparable to that of abdominoperineal resection. In their recent brief communication Langer and colleagues present the opposite view and we believe they too have overstated their case. They compare their own cases, selected because of operability and resectability, with a group referred for radiation because of inoperability, and they use actuarial survival rates for the surgical cases against Rider's crude (unimproved) survival rates for the radiotherapy cases. We regard. the absolute 5-year survival rate of 29% in Rider's cases as very creditable if most of the survivors truly had inoperable tumours. It certainly raises hopes of obtaining acceptable cure rates if radiotherapy is applied to more favourable cases. We also believe that the value of preoperative radiotherapy in cancer of the lower rectum has been proven.'3 Perhaps cases with only relative contraindications to surgery should now be given a trial of curative radiotherapy. W. MUIRHEAD, MB, FRCP[C], DMRT A.F. PHILLIPS, MD, FRCP[C], DMRT

overseas degree (from Australia) suddenly became interested, and even phoned when they learned that my wife's father was an American. I wondered what this had to do with medical competence. I close with a parting shot at our Canadian system. Anyone who has tried to transfer from one province to another, or even from one hospital to another within the same city, has been frustrated by the ridiculous amount of documentation required, to say nothing of inconvenience and expense, especially when all the information that could conceivably be required on anyone is already in Ottawa, at least for licentiates of the Medical Council of Canada. Why must it be so? GORDON E. POTrER, MB, 135 219½ - 5th Ave. N Saskatoon, Sask

Management of hypothermia

To the editor: In a recent communication (Can Med Assoc J 117: 1372, 1977) Dr. James B. Rueler commented on resuscitation of a patient with profound hypothermia as reported by Dr. V. Wood in another issue of the Journal (117: 16, 1977). I endorse Rueler's remarks regarding the use of core rewarming methods in the treatment of hypothermia. In the past few years, especially in the JourOntario Cancer Foundation Hamilton, Ont. nal, the treatment of hypothermia has been discussed at some length. I believe most physicians who have been followReferences ing this ongoing discussion are much 1. RIDER WD: The 1975 Gordon Richards clearer in their minds as to the best Memorial Lecture: Is the Miles operation procedures to be used, and have taken really necessary for the treatment of rectal cancer? J Can Assoc Radlol 26: 167, 1975 steps to see that their hospitals are 2. RoswIT B, HIGGINs GA, KEEHN RJ: Preequipped to deal with this emergency. operative irradiation for carcinoma of rectum My articles1'2 were prepared when there and rectosigmoid colon - report of a National Veterans Administration randomized was little readily available knowledge study. Cancer 35: 1597, 1975 on the problem, certainly in the con3. KLIGEItMAN MM: Radiotherapy and rectal text of an emergency occurring in a cancer. Cancer 39 (suppl 2): 896, 1977 small community hospital. The method used there was successful, but this was only one case. In similar circumstances Physicians on the move now I would not hesitate to use core To the editor: The recent flurry of rewarming techniques and we have American agencies advertising in Cana- facilities to do this. The only time I would advocate exdian journals for physicians finally aroused my curiosity. One day, when ternal rewarming would be when the the temperature was -400C, I wrote facilities do not exist to heat the core, a few letters of inquiry. As the replies although even the most minimally trickle in, I am astounded by the equipped outpost should be able to ridiculous array of requirements placed manage colonic infusions of warm in one's way. If the tests from the water. Federation of Licensing Examinations P.K. HUNT, MB, B cH, CCFP[C] Fort Saskatchewan Medical Clinic need to be done the advertisements Fort Saskatchewan, Alta. should say so to save one a lot of time. It would also be interesting to know why these examinations should References be required of one holding the licen1. HUNT PK: Effect and treatment of the "divtiate of the Medical Council of Caning reflex". Can Med Assoc 1 111: 1330, 1974 ada. One outfit, having sent me a 2. Idem: Treatment of hypothermia (C). Can Med Assoc 1 112: 931, 1975 fairly negative reply in view of my

618 CMA JOURNAL/MARCH 18, 1978/VOL. 118

Management of hypothermia.

suitably selected group of patients. It seems possible that these are the same patients who are most likely to benefit from abdominoperineal resection...
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