Patterns of recurrence following high-dose preoperative radiation and sphincter-preserving surgery for cancer of the rectum
Patterns of recurrence following high-dose preoperative radiation and sphincter-preserving surgery for cancer of the rectum
复制标题
直肠癌术前大剂量放疗和保肛手术后的复发模式
DOI：
10.1007/bf02051166
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发表时间：
1993
影响因子：
3.9
通讯作者：
Gerald Marks
中科院分区：
文献类型：
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作者：
M. Mohiuddin;Gerald Marks
高剂量术前放疗结合新的保肛手术方案治疗直肠远端癌和不利的直肠癌，作为腹会阴切除术和永久性结肠造口术的替代方案，正得到越来越多的认可。从1976年至1989年，161例直肠癌患者进入一个程序的高剂量术前放射和根治性保肛手术。选择是基于不可切除性或肿瘤位置在直肠低位的前瞻性临床分期。所有患者在4周半内接受了4，000至4，500 cGy的最小剂量，分次剂量为180至250 cGy。肿瘤固定的患者使用锥形下降野额外增加1，000至1，500 cGy，总计5，500至6，000 cGy。手术在放射治疗完成后4至8周进行。14例患者，在手术中发现有肝转移，姑息性切除治疗。147例患者接受了保留括约肌的根治性手术。手术方式包括腹骶联合切除术（63例）、经肛-腹-经肛联合切除术（53例）和前切除术（31例）。随访时间从最少2年到15年不等，中位数为5年。无围手术期死亡。3例患者发生吻合失败，其中2例进行了重建。另外10名患者需要晚期分流，主要是因为疾病复发。147例患者中有134例（91%）保持了长期正常的括约肌功能。18例患者（12.4%）观察到盆腔会阴复发，其中12例患者的固定肿瘤位于直肠远端6 cm以下。中位局部复发时间为24个月。35例患者发生远处转移伴或不伴局部复发，其中22例肿瘤固定在直肠水平6cm以下。中位远处转移时间为17个月。43名患者死亡，32人死于疾病。总患者组的总体五年Kaplan-Meier精算生存率为79%，无病生存率为73%。本研究的结果表明，术前大剂量放疗结合根治性保肛手术技术，可使疾病得到良好的局部控制，提高生存率，提高生活质量，并保留正常的肛门括约肌功能。
: High-dose preoperative radiation with new sphincter-preserving surgical options for the management of distal and unfavorable cancers of the rectum is gaining recognition as an alternative to abdominoperineal resection and permanent colostomy. From 1976 to 1989, 161 patients with cancer of the rectum were entered into a program of high-dose preoperative radiation and radical sphincter-preserving surgery. Selection was based on prospective clinical staging of unfavorability or tumor location at a low level in the rectum. All patients received a minimum dose of 4,000 to 4,500 cGy over 4 1/2 weeks in fractional doses of 180 to 250 cGy. Patients with tumor fixation were given an additional boost of 1,000 to 1,500 cGy for a total of 5,500 to 6,000 cGy using a coned-down field. Surgery was carried out four to eight weeks following completion of radiation. Fourteen patients, found at surgery to have liver metastasis, were treated by palliative resection. One hundred forty-seven patients underwent radical curative surgery with sphincter preservation. The surgical procedures performed were combined abdominotranssacral resection (63), transanal-abdominal-transanal resection (53), and anterior resection (31). Follow-up ranged from a minimum of two years to 15 years, with a median of five years. There was no perioperative mortality. Anastomotic failure occurred in three patients, two of whom were reconstituted. Late diversion was required in 10 other patients, primarily for recurrent disease. One hundred thirty-four of the 147 patients (91 percent) maintained long-term normal sphincter function. Pelvic-perineal recurrence was observed in 18 patients (12.4 percent), 12 of whom had fixed tumors located below the 6-cm level of the distal rectum. Median time to local recurrence was 24 months. Distant metastasis with or without local recurrence occurred in 35 patients, 22 of whom had fixed tumors below the 6-cm level of the rectum. Median time to distant metastasis was 17 months. Forty-three patients have died, 32 of disease. The overall five-year Kaplan-Meier actuarial survival for the total group of patients is 79 percent, with a disease-free survival of 73 percent. The findings of this study indicate that high-dose preoperative radiation used in combination with radical sphincter-preserving surgical techniques results in excellent local control of disease, improved survival, and enhanced quality of life with retention of normal anal sphincter function.
癌症免疫学.免疫其他.(1986)
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