Intraoperative and external beam irradiation for locally advanced colorectal cancer.
Intraoperative and external beam irradiation for locally advanced colorectal cancer.
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局部晚期结直肠癌的术中和外照射。
DOI：
10.1097/00000658-198801000-00011
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发表时间：
1988
影响因子：
9
通讯作者：
McIlrath,DC
中科院分区：
文献类型：
--
作者：
Gunderson,LL;Martin,JK;Bèart,RW;Nagorney,DM;Fieck,JM;Wieand,HS;Martinez,A;O'Connell,MJ;Martenson,JA;McIlrath,DC
鉴于标准治疗获得的局部控制率较差，对51例局部晚期结直肠癌患者（复发36例，原发15例）采用电子术中放射（IORT）联合外束照射和手术切除，加或不加5-氟尿嘧啶（5FU）治疗。患者接受4500-5500 cGy （rad）的分次、多场外束照射和1000-2000 cGy的IORT剂量。51例患者中有30例（59%）存活，22例（43%）无疾病。在44例风险大于或等于1年的患者中，44例中有1例（2%）发生IORT视野局部进展，44例中有8例（18%）发生外束视野局部进展。所有局部失败都发生在复发或部分切除后总残留的患者中，并且在外照射期间接受5FU的患者的风险较低（11.9%的1例对31.19%的6例）。在复发的患者中，远处转移的发生率很高，但随后的腹膜衰竭并不常见。急性和慢性耐受性已被接受，但周围神经似乎是一个剂量限制结构。需要随机试验来确定IORT的潜在收益是否真实。
In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real.