REIRRADIATION FOR RECTAL-CANCER AND SURGICAL RESECTION AFTER ULTRA-HIGH DOSES
REIRRADIATION FOR RECTAL-CANCER AND SURGICAL RESECTION AFTER ULTRA-HIGH DOSES
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DOI：
10.1016/0360-3016(93)90538-7
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发表时间：
1993-12-01
影响因子：
7
通讯作者：
MARKS, G
中科院分区：
文献类型：
--
作者：
MOHIUDDIN, M;LINGAREDDY, V;MARKS, G
目的：大剂量盆腔放疗后直肠癌局部复发是一个困难的管理挑战。传统的智慧认为，应避免再照射和根治性盆腔手术是危险的超高剂量radiation.Methods和材料后：在一个独特的I/II期试点研究，32例复发直肠癌后，以前的盆腔放射性计划再照射骨盆。最初的辐射剂量为30-64。87戈伊（中位剂量45戈伊）。17例患者接受了再照射，然后进行了根治性切除。15例患者接受了再次放疗，以缓解症状。治疗技术包括两个侧野（7 × 7至12 × 10 cm），包围肿瘤，边缘2 cm。再照射剂量范围为19.80-47.66戈伊（中位数34.2戈伊）。患者还同时接受低剂量连续输注化疗（5-FU 200-300 mg/天）。总累积放射剂量为70.6 ~ 111.6戈伊。4例患者因腹泻或白细胞减少而中断/停止放射治疗。随访时间为6个月至36个月。迄今为止，没有观察到辐射的晚期后遗症。17例患者在再照射后6-8周接受手术探查。2例患者有广泛的疾病，没有被切除。15例患者接受了残余肿瘤根治性切除术（4例后路切除术，6例APR，3例经肛门腹式经肛门直肠结肠切除结肠肛门吻合术（TAATA），2例LAR）。无患者术后死亡。未观察到过度水肿、出血或粘连。2例患者发生盆腔脓肿，1例发生结肠肛门狭窄。15例切除患者中有11例存活6 ~ 36个月，2年生存率为66%。在接受姑息治疗的患者中，13/15例患者的症状缓解。没有观察到客观的完全缓解，但6/15例患者有可测量的部分缓解。本组中位生存期为14个月。结论：根据这一经验，我们认为，在选定的患者根治性手术切除后，累积超高剂量（70-90戈伊）的辐射可以安全地进行。尽管剂量很高，但可行的吻合术也是可能的。有计划的再照射姑息性缓解症状可以是有效的，没有不寻常的并发症的风险。继续监测这种超高剂量辐射和手术的长期影响。
Purpose: Local recurrence of rectal cancer following high-dose pelvic radiation presents a difficult management challenge. Conventional wisdom suggests that reirradiation should be avoided and radical pelvic surgery is hazardous after ultra high-dose radiation.Methods and Materials: In a unique Phase I/II pilot study, 32 patients with recurrent rectal cancers following previous pelvic radiation underwent planned reirradiation to the pelvis. Initial radiation doses had ranged from 30-64. 87 Gy (median dose 45 Gy). Seventeen patients underwent reirradiation followed by radical resection. Fifteen patients were reirradiated for palliative relief of symptoms. Treatment techniques consisted of two lateral fields (7 X 7 to 12 X 10 cm) encompassing the tumor with 2 cm margins. Reirradiation doses ranged from 19.80-47.66 Gy, (median 34.2 Gy). Patients also received concurrent low-dose continuous infusion chemotherapy, (5-FU 200-300 mg/day). Total cumulative radiation doses ranged from 70.6 to 11 1.6 Gy.Results: Treatment was well tolerated. Four patients had radiation interrupted/discontinued for diarrhea or leukopenia. Follow-up ranges from 6 months to 36 months. No late sequelae of radiation have been observed to date. Seventeen patients underwent surgical exploration 6-8 weeks following reirradiation. Two patients had extensive disease and were not resected. Fifteen patients underwent radical resection of residual tumor (4 posterior exenterations, 6 APR, 3 transanal abdominal transanal proctocolectomy with coloanal anastomosis (TAATA), and 2 LAR). No patients died postoperatively. No excessive edema, hemorrhage, or adhesions were observed. Two patients developed pelvic abscess and one developed a coloanal stricture. Eleven of 15 resected patients are alive from 6 to 36 months with a 2-year survival of 66%. Of the patients treated palliatively, symptomatic relief was observed in 13/15 patients. No objective complete response was observed, but 6/15 patients had measurable partial response. Median survival in this group was 14 months.Conclusion: Based on this experience, we believe that in selected patients radical surgical resection after cumulative ultra high doses (70-90 Gy) of radiation can be performed safely. A viable anastomosis is also possible in spite of these high doses. Planned reirradiation for palliative relief of symptoms can be effective without unusual risks of complication. Long-term effects of such ultra high dose radiation and surgery continue to be monitored.