Adverse effects of preoperative radiation therapy for rectal cancer:: Long-term follow-up of the Swedish rectal cancer trial
Adverse effects of preoperative radiation therapy for rectal cancer:: Long-term follow-up of the Swedish rectal cancer trial
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DOI：
10.1200/jco.2005.02.9017
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发表时间：
2005-12-01
影响因子：
45.3
通讯作者：
Glimelius, B
中科院分区：
文献类型：
--
作者：
Birgisson, H;Påhlman, L;Glimelius, B
目的 分析直肠癌术前放疗患者亚急性和晚期不良反应的发生情况。 患者和方法 研究人群包括 1,147 名患者，这些患者在 1987 年至 1990 年进行的瑞典直肠癌试验中被随机分配接受术前放疗或单独手术。患者数据与瑞典医院出院登记册相匹配，以确定直肠癌初步治疗后入院的患者。排除已知残留疾病的患者，并在复发日期前 3 个月对复发患者进行审查。计算了 95% CI 的相对风险 (RR)。 结果 接受放射治疗的患者在初次治疗后的前 6 个月内入院风险增加（RR = 1.64；95% CI，1.21 至 2.22）；这些主要用于胃肠道诊断。总体而言，两组在初次治疗后 6 个月以上入院的风险没有差异（RR = 0.95；95% CI，0.80 至 1.12）。然而，就具体诊断而言，接受放射治疗的患者因不明感染、肠梗阻、腹痛和恶心而在初次治疗后 6 个月后入院的 RR 有所增加。 结论 胃肠道疾病导致入院，似乎是直肠癌患者术前短期放疗最常见的不良反应。肠梗阻是潜在最重要的诊断，在接受放射治疗的患者中肠梗阻比未接受放射治疗的患者更常见。
Purpose To analyze the occurrence of subacute and late adverse effects in patients treated with preoperative irradiation for rectal cancer.Patients and Methods The study population included 1,147 patients randomly assigned to preoperative radiation therapy or surgery alone in the Swedish Rectal Cancer Trial conducted 1987 through 1990. Patient data were matched against the Swedish Hospital Discharge Register to identify patients admitted to hospital after the primary treatment of the rectal cancer. Patients with known residual disease were excluded, and patients with a recurrence were censored 3 months before the date of recurrence. Relative risks (RR) with 95% CIs were calculated.Results Irradiated patients were at increased risk of admissions during the first 6 months from the primary treatment (RR = 1.64; 95% CI, 1.21 to 2.22); these were mainly for gastrointestinal diagnoses. Overall, the two groups showed no difference in the risk of admissions more than 6 months from the primary treatment (RR = 0.95; 95% CI, 0.80 to 1.12). Regarding specific diagnoses, however, RRs were increased for admissions later than 6 months from the primary treatment in irradiated patients for unspecified infections, bowel obstruction, abdominal pain, and nausea.Conclusion Gastrointestinal disorders, resulting in hospital admissions, seem to be the most common adverse effect of short-course preoperative radiation therapy in patients with rectal cancer. Bowel obstruction was the diagnosis of potentially greatest importance, which was more frequent in irradiated than in nonirradiated patients.