No downstaging after short-term preoperative radiotherapy in rectal cancer patients
No downstaging after short-term preoperative radiotherapy in rectal cancer patients
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DOI：
10.1200/jco.2001.19.7.1976
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发表时间：
2001-04-01
影响因子：
45.3
通讯作者：
van Krieken, JHJM
中科院分区：
文献类型：
--
作者：
Marijnen, CAM;Nagtegaal, ID;van Krieken, JHJM
目的：在回顾性研究中，全肠系膜切除（TME）手术已被证明可以减少直肠癌局部复发的数量。关于术前低分割放疗后局部控制改善的报道导致了一项随机多中心试验的引入，以评估术前放疗和不放疗TME手术的效果。术前放疗可能对决定直肠癌分期的病理特征有影响。我们调查了直肠癌患者术前接受和未接受放疗的降分期的发生情况。患者和方法：我们分析了1321例随机试验患者的肿瘤大小、检查淋巴结数量、肿瘤-淋巴结转移分期和组织病理学特征的差异。该试验比较了术前放疗（5 x 5 Gy）后TME手术与单独TME手术。从放疗开始到手术间隔超过10天的患者被排除在分析之外。结果：两组在肿瘤大小（P < 0.001）和淋巴结总数（P < 0.001）上均有差异。检测到的肿瘤或淋巴结分类无差异。放疗组表现出更多的低分化肿瘤和更多的粘液性肿瘤。结论：在直肠癌患者中，如果放疗开始与手术间隔不超过10天，术前短期5 x 5 Gy放疗不会导致分期下降。(C) 2001年美国临床肿瘤学会。
Purpose: In retrospective studies, total mesorectal excision (TME) surgery has been demonstrated to result in a reduction in the number of local recurrences of rectal cancer. Reports on improved local control after preoperative, hypofractionated radiotherapy have led to the introduction of a randomized multicenter trial to evaluate the effect of TME surgery with and without preoperative radiotherapy. Treatment with preoperative radiotherapy might have an effect on the pathologic characteristics that determine staging of rectal cancer. We investigated the occurrence of downstaging in rectal cancer patients treated with and without preoperative radiotherapy.Patients and Methods: We analyzed the differences in tumor size, number of examined lymph nodes, tumor-node-metastasis stage, and histopathologic features in 1,321 patients entered onto a randomized trial. The trial compared preoperative radiotherapy (5 x 5 Gy) followed by TME surgery with TME surgery alone. Patients who had an interval of more than 10 days between the start of radiotherapy and surgery were excluded from analysis.Results: Differences were observed in tumor size (P < .001) and total number of examined lymph nodes (P < .001). No difference in tumor or node classification wets detected. The irradiated group demonstrated more poorly differentiated tumors as well as more mucinous tumors.Conclusion: In rectal cancer patients, short-term, preoperative radiotherapy with 5 x 5 Gy does not lead to downstaging if the interval between the start of radiotherapy and surgery does not exceed 10 days. (C) 2001 by American Society of Clinical Oncology.