Preoperative "chemoradiation" for stages II and III rectal carcinoma.

Preoperative "chemoradiation" for stages II and III rectal carcinoma.
复制标题

II 期和 III 期直肠癌的术前“放化疗”。

DOI：
--
复制
发表时间：
1996
期刊：
Archives of Surgery
影响因子：
--
通讯作者：
S. Poticha
S. Poticha
中科院分区：
--
文献类型：
--
作者：
S. Stryker;K. Kiel;A. Rademaker;J. Shaw;G. Ujiki;S. Poticha

文献摘要

被引文献

相似文献

目的 确定与未接受术前放化疗的患者相比，II期或III期直肠癌患者术前联合化疗和外照射（“放化疗”）是否对围手术期发病率和肿瘤结局产生影响。 设计 对一组接受术前放化疗的II期或III期直肠癌患者进行前瞻性随访，并以非随机方式与相似患者的初始队列组进行比较。 设置 西北纪念医院，芝加哥，伊利诺伊州，三级护理学术医疗中心。 患者 将30例接受术前放化疗的直肠癌患者与56例未接受术前放化疗的患者以及24例接受标准术后辅助放化疗的患者进行比较。 干预 在手术切除前4 ~ 8周，同时给予45 ~ 50戈伊的外照射和氟尿嘧啶及丝裂霉素。 主要观察指标 定期随访患者的肿瘤复发或死亡。此外，对接受术前放化疗的组的主要术前发病率进行了评价。 结果 所有同意术前放化疗的患者均完成治疗。该组围手术期主要发病率（13%）与先前发表的结果相当。在56例未接受术前放化疗的II期或III期直肠癌患者中，仅24例（43%）完成了标准术后辅助放化疗。接受术前放化疗的患者（n = 30）、未接受术前放化疗的患者（n = 56）和未接受术前放化疗但完成标准术后放化疗的患者（n = 24）分别接受了平均39个月、31个月和32个月的随访。5年精算局部控制率分别为96%、83%和88%。无病生存率分别为80%、57%和47%。总生存率分别为85%、48%和78%。 结论 术前放化疗治疗II期或III期直肠癌的耐受性良好，且与随后围手术期主要发病率的增加无关。此外，局部控制、无病生存和总生存率与接受标准术后辅助放化疗的非随机初始队列组患者相比更为有利。
OBJECTIVE To determine whether preoperative administration of combination chemotherapy and external beam irradiation ("chemoradiation") for patients with stage II or stage III rectal carcinoma had an impact on perioperative morbidity on oncologic outcome, as compared with patients not receiving preoperative chemoradiation. DESIGN A group of patients with stage II or stage III rectal carcinoma receiving preoperative chemoradiation were followed up prospectively and compared in a nonrandomized fashion with an inception cohort group of similar patients. SETTING Northwestern Memorial Hospital, Chicago, Ill, a tertiary care academic medical center. PATIENTS Thirty patients with rectal carcinoma undergoing preoperative chemoradiation were compared with 56 patients not undergoing preoperative chemoradiation, and also with a subset group of 24 patients who received standard postoperative adjuvant chemoradiation. INTERVENTION External beam radiation, 45 to 50 Gy, was delivered concurrently with fluorouracil and mitomycin 4 to 8 weeks prior to surgical resection. MAIN OUTCOME MEASURES Patients were followed up at regular intervals for either tumor recurrence or death. In addition, the group receiving preoperative chemoradiation was evaluated for major preoperative morbidity. RESULTS All patients agreeing to preoperative chemoradiation completed therapy. Perioperative major morbidity in this group (13%) was comparable to previously published results. Of the 56 patients with stage II or stage III rectal carcinoma not receiving preoperative chemoradiation, only 24 (43%) completed standard postoperative adjuvant chemoradiation. Patients receiving preoperative chemoradiation (n = 30), patients not receiving preoperative chemoradiation (n = 56), and the subset of the group not receiving preoperative chemoradiation who completed standard postoperative chemoradiation (n = 24) were followed up for a mean of 39 months, 31 months, and 32 months, respectively. Five-year actuarial local control rates were 96%, 83%, and 88%, respectively. Disease-free-survival rates were 80%, 57%, and 47%, respectively. Overall survival rates were 85%, 48%, and 78%, respectively. CONCLUSIONS Preoperative chemoradiation in the treatment of stage II or stage III rectal carcinoma is well tolerated and not associated with an increase in subsequent perioperative major morbidity. In addition, local control, disease-free survival, and overall survival compare favorably with a nonrandomized inception cohort group of patients receiving standard postoperative adjuvant chemoradiation.