Curative surgical resection following reirradiation for recurrent rectal cancer
Curative surgical resection following reirradiation for recurrent rectal cancer
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DOI：
10.1016/s0360-3016(97)00340-4
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发表时间：
1997-10-01
影响因子：
7
通讯作者：
Marks, J
中科院分区：
文献类型：
--
作者：
Mohiuddin, M;Marks, GM;Marks, J
目的：尽管进行了连续的放疗和化疗，但仍有10 - 25%的直肠癌切除患者会出现盆腔局部复发。本研究评估了复发直肠癌再放疗后残余病变根治性手术切除的可能性。方法和材料：三十-9例直肠腺癌复发的患者在既往的连续治疗后接受了盆腔再照射，同时静脉注射输注5-氟尿嘧啶。初次治疗后的中位复发时间为18个月，既往盆腔放疗剂量范围为40 - 66戈伊，中位剂量为50.4戈伊，再次放疗剂量范围为20戈伊-49.2戈伊，中位总剂量为36戈伊，再次放疗后8 - 12周患者接受了疾病手术切除，31例患者进行了肿瘤大体全切除，结果如下：复发性直肠癌患者在再次放疗后随访24个月至75个月，中位随访时间为3年。再照射耐受性良好，7例患者需要显著的治疗中断，5例患者因腹泻、潮湿脱皮或粘膜炎而提前终止再照射。无手术死亡，术后2例患者出现伤口延迟愈合，晚期并发症包括6例发生小肠梗阻，3例发生肠瘘，患者中位生存期为45个月，5年精算生存率为24%。5年局部控制率为45%，远处转移率为17%。结论：经选择的直肠癌患者在接受辅助治疗后出现复发，可在再次放疗/化疗后成功进行根治性手术切除，长期生存率显著。(C)1997年爱思唯尔科学公司
Purpose: In spite of adjunctive radiation and chemotherapy, 10 to 25% of patients with resected rectal cancer develop local recurrence in the pelvis, This study evaluates the potential for curative surgical resection of residual disease following reirradiation for recurrent rectal cancer.Methods and Materials: Thirty-nine patients with recurrent adenocarcinoma of the rectum following prior adjunctive therapy underwent reirradiation of the pelvis with concurrent intravenous infusion of 5-fluorouracil. Median time to recurrence following initial treatment was 18 months, Prior radiation doses to the pelvis ranged from 40 to 66 Gy with a median of 50.4 Gy, Reirradiation doses ranged from 20 Gy to 49.2 Gy with a median total dose of 36 Gy, Eight to 12 weeks following reirradiation patients underwent surgical resection of disease, Thirty-one patients had gross total resection of tumor,Results: Patients have been followed for 24 months to 75 months after reirradiation for recurrent rectal cancer with a median follow-up of 3 years. Reirradiation was well tolerated, with seven patients requiring a significant treatment break, Early termination of reirradiation occurred in five patients because of diarrhea, moist desquamation, or mucositis. No surgical mortality was observed, Postoperatively, two patients developed delayed wound healing, Late complications included six patients who developed small bowel obstruction with three patients developing a bowel fistula, The median survival of patients is 45 months, with a 5-year actuarial survival of 24%. Actuarial local control at 5 years was 45%, The rate of distant metastases was 17%,Conclusion: Selected patients with rectal cancer who develop recurrent disease following previous adjuvant therapy can undergo successful curative surgical resection following reirradiation/chemotherapy with significant long-term survival. (C) 1997 Elsevier Science Inc.