The role of intra-operative irradiation in locally advanced primary and recurrent rectal adenocarcinoma.
The role of intra-operative irradiation in locally advanced primary and recurrent rectal adenocarcinoma.
复制标题
术中照射在局部晚期原发性和复发性直肠腺癌中的作用。
DOI：
10.1007/bf02104454
复制
发表时间：
1992
影响因子：
2.6
通讯作者：
Dozois,RR
中科院分区：
文献类型：
--
作者：
Gunderson,LL;O'Connell,MJ;Dozois,RR
当使用外照射和化疗（联合或不联合切除）的标准治疗方法治疗局部晚期原发性直肠恶性肿瘤时，通常可以实现有效的姑息治疗。然而，由于周围器官和组织的辐射耐受性有限，只有 10% 至 50% 的患者能够实现局部控制和长期生存。马萨诸塞州总医院和梅奥诊所在局部控制的改善和局部晚期直肠病变的可能生存方面存在令人鼓舞的趋势，需要对此类方法进行持续评估。然而，当外科医生无法完成大体全切除时，术中和外部照射野内的疾病控制就会降低。因此，在外部照射期间持续添加含或不含亚叶酸的 5-氟尿嘧啶，并结合术中照射评估剂量调节剂（例如增敏剂或热疗）的使用似乎是合理的。由于局部晚期原发性病变和复发性病变均存在较高的全身失败率，因此需要在外部照射期间以及完成后评估更有效的化疗。鉴于 5-氟尿嘧啶联合亚叶酸与单独使用 5-氟尿嘧啶治疗转移性疾病相比具有生存优势，目前正在采用该方案。即使对于局部复发性病变，包括术中放疗在内的积极多模式治疗也改善了局部控制，长期生存率达到 20% 至 25%，而历史系列中传统技术的预期生存率为 5%。
Useful palliation can often be achieved when standard treatment approaches of external beam irradiation and chemotherapy with or without resection are used for locally advanced primary rectal malignancies. Local control and long‐term survival are achieved in only 10% to 50% of patients, however, due to the limited irradiation tolerance of surrounding organs and tissues. Encouraging trends exist in separate intra‐operative irradiation analyses from Massachusetts General Hospital and Mayo Clinic with regard to improvement in local control and possibly survival of locally advanced rectal lesions, warranting continued evaluation of such approaches. Disease control within the intra‐operative and external irradiation field is decreased, however, when the surgeon is unable to accomplish gross total resection. Therefore it seems reasonable to consistently add 5‐Fluorouracil with or without Leucovorin during external irradiation and to evaluate the use of dose modifiers, such as sensitizers or hyperthermia, in conjunction with intra‐operative irradiation. Since high systemic failure rates exist with both locally advanced primary and recurrent lesions, more effective chemotherapy needs to be evaluated during external irradiation as well as after completion of such. In view of survival advantages with 5‐Fluorouracil plus Leucovorin versus 5‐Fluorouracil alone for metastatic disease, this regimen is currently being employed. Even with locally recurrent lesions, the aggressive multimodality approaches including intra‐operative irradiation have resulted in improved local control, and long‐term survival rates of 20% to 25% versus an expected 5% with conventional techniques in historical series.