Preoperative infusional chemoradiation therapy for stage T3 rectal cancer.
Preoperative infusional chemoradiation therapy for stage T3 rectal cancer.
复制标题
T3期直肠癌的术前输注放化疗。
DOI：
10.1016/0360-3016(95)00020-y
复制
发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Roubein,LD
中科院分区：
文献类型：
--
作者：
Rich,TA;Skibber,JM;Ajani,JA;Buchholz,DJ;Cleary,KR;Dubrow,RA;Levin,B;Lynch,PM;Meterissian,SH;Roubein,LD
目的：探讨直肠癌术前灌注放化疗的疗效。方法和材料：本文报告77例T_3期直肠癌患者术前应用氟尿嘧啶（5 FU）300 mg/m2/d灌注加放疗（45 Gy/25次/5周）。63例患者的内镜超声检查证实了直肠指诊。手术在放化疗完成后约6周进行，包括25例腹会阴切除术和52例肛门括约肌保留手术。结果：治疗后肿瘤分期为T1 -2、NO者占35%，T3、NO者占25%，T1 -3、N1者占11%，无肿瘤证据者占29%。放化疗后局部肿瘤控制率为96%（74/77）; 2例患者吻合部位疾病复发，经腹会阴切除术成功治疗。总体而言，99%（76/77）的患者获得了盆腔控制。放化疗后无淋巴结转移的患者生存率高于有淋巴结转移的患者（≤ ns）。病理学完全缓解或仅显微镜下病灶的患者存活率高于大体残留肿瘤的患者（0，= 0.07）。3年时的精算生存率为83%;中位随访时间为27个月，范围为3至68个月。急性，围手术期和晚期并发症并没有更多或更严重的放化疗比传统的放射治疗（XRT）单独。结论：优秀的治疗反应允许三分之二的患者有肛门括约肌保留程序。切除标本中的大体残留病变表明预后不良，针对这些患者的治疗可能会进一步提高生存率。
Purpose: To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer. Methods and Materials: Preoperative chemoradiation therapy using infusional Whtorouracil(5FU),(300 mg/m’/day) together with daily irradiation(45 Gyl25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures. Results: Posttreatment tumor stages were Tl-2, NO in 35%, T3 NO in 25%, and Tl-3, Nl in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96%(74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99%(76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement@= ns). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor 0,= 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone.Conclusions: Excellent treatment response allowed two-thirds of the patients to have an anal-sphinctersparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further.