Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer
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DOI：
10.1056/nejmoa010580
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发表时间：
2001-08-30
影响因子：
158.5
通讯作者：
van de Velde, CJH
中科院分区：
文献类型：
--
作者：
Kapiteijn, E;Marijnen, CAM;van de Velde, CJH
背景：短期术前放疗和全肠系膜切除均可改善可切除直肠癌患者的局部疾病控制。我们进行了一项多中心随机试验，以确定术前放疗是否会增加全肠系膜切除术的益处。方法：我们随机分配了1861例可切除的直肠癌患者，其中924例接受术前放疗（5 Gy，每次5天），然后进行全肠系膜切除（937例），或单独进行全肠系膜切除（937例）。试验采用标准化和质量控制措施进行，以确保放疗、手术和病理技术的一致性。结果：1861名患者被随机分配到两个治疗组中，1805名患者符合条件。在符合条件的患者中，放疗和手术组的两年总生存率为82.0%，而单独手术组的生存率为81.8% （P=0.84）。在1748例接受宏观完全局部切除的患者中，两年内局部复发率为5.3%。两年后局部复发率，放疗加手术组为2.4%，单纯手术组为8.2%
Background: Short-term preoperative radiotherapy and total mesorectal excision have each been shown to improve local control of disease in patients with resectable rectal cancer. We conducted a multicenter, randomized trial to determine whether the addition of preoperative radiotherapy increases the benefit of total mesorectal excision.Methods: We randomly assigned 1861 patients with resectable rectal cancer either to preoperative radiotherapy (5 Gy on each of five days) followed by total mesorectal excision (924 patients) or to total mesorectal excision alone (937 patients). The trial was conducted with the use of standardization and quality-control measures to ensure the consistency of the radiotherapy, surgery, and pathological techniques.Results: Of the 1861 patients randomly assigned to one of the two treatment groups, 1805 were eligible to participate. The overall rate of survival at two years among the eligible patients was 82.0 percent in the group assigned to both radiotherapy and surgery and 81.8 percent in the group assigned to surgery alone (P=0.84). Among the 1748 patients who underwent a macroscopically complete local resection, the rate of local recurrence at two years was 5.3 percent. The rate of local recurrence at two years was 2.4 percent in the radiotherapy-plus-surgery group and 8.2 percent in the surgery-only group (P