Preoperative radiation therapy for clinically resectable adenocarcinoma of the rectum.
Preoperative radiation therapy for clinically resectable adenocarcinoma of the rectum.
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临床可切除直肠腺癌的术前放射治疗。
DOI：
10.1097/00000658-198508000-00012
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发表时间：
1985
影响因子：
9
通讯作者：
E. Copeland
中科院分区：
文献类型：
--
作者：
W. Mendenhall;R. Million;K. Bland;W. Pfaff;E. Copeland
本研究分析了1975年7月至1981年12月在佛罗里达大学接受术前放疗和手术治疗的71例临床可切除的直肠腺癌患者。7例患者手术时发现肝转移；其中6例完全切除了原发直肠病变，1例完全切除了直肠肿瘤。其余64例患者在手术时没有转移的迹象，并接受了直肠癌的完全切除。在试验的早期，最大肿瘤剂量为3000至3500 rad，在3.5至4周内；随后，剂量在5周内增加到4500 rad。患者在放疗完成后2 - 11周（平均3.5周）接受手术。所有患者至少有3年的随访，63%的患者至少有5年的随访。治疗的急性并发症是可以接受的，只有一个病人需要治疗会阴湿脱屑休息。所有患者均完成放疗疗程，均行手术治疗。手术标本病理检查未见肿瘤占11%，淋巴结阳性发生率为19%，为1959 - 1976年单独手术治疗的一系列历史对照中淋巴结阳性发生率的一半。术前放疗加手术治疗的患者与单纯手术治疗的患者比较发现，术后并发症的发生率、分布和严重程度相似。无术后死亡病例。局部复发的总发生率为5/64(7.8%)，局部复发和/或远处转移的合并发生率为18/64（28%）。3000 ~ 3500 rad的局部-区域复发率术前剂量为3/23 (13%)，4000 ~ 5000 rad的局部-区域复发率为2/41（5%）。术前放疗组5年局部-区域失败率为3/40(7.5%)，单纯手术治疗的历史对照组5年局部-区域失败率为39/135(29%)（显著性水平= 0.015）。术前放疗患者的5年确定无病生存率为27/38(71%)，单纯手术组患者的5年确定无病生存率为47/114(41%)（显著性水平= 0.008）。
: This is an analysis of 71 patients with clinically resectable adenocarcinoma of the rectum treated with preoperative irradiation and surgery at the University of Florida from July 1975 through December 1981. Seven patients were found to have liver metastasis at surgery; six had a complete resection of their primary rectal lesion and one had an incomplete resection of the rectal tumor. The remaining 64 patients had no evidence of metastasis at the time of surgery and underwent a complete resection of their rectal cancer. In the early years of the trial, the maximum tumor dose consisted of 3000 to 3500 rad in 3.5 to 4 weeks; the dose was subsequently increased to 4500 rad in 5 weeks. Patients were taken to surgery between 2 and 11 weeks (mean, 3.5 weeks) following the completion of radiation therapy. All patients have a minimum follow-up of 3 years and 63% have a minimum follow-up of 5 years. The acute complications of treatment have been acceptable, with only one patient requiring a treatment rest for moist desquamation of the perineum. All patients completed the irradiation course and all were operated on. Pathologic examination of the surgical specimen revealed no tumor in 11%, and the incidence of positive lymph nodes was 19%, which was half the incidence of positive lymph nodes in a series of historical controls treated from 1959 to 1976 with surgery alone. Comparison of patients treated with preoperative irradiation and surgery with those treated with surgery alone revealed that the postoperative complications have been similar in incidence, distribution, and severity. There have been no postoperative deaths. The overall incidence of local-regional recurrence is 5/64 (7.8%), and the combined incidence of local-regional recurrence and/or distant metastasis is 18/64 (28%). The incidence of local-regional recurrence by preoperative dose is 3/23 (13%) for doses of 3000 to 3500 rad and 2/41 (5%) for doses of 4000 to 5000 rad. The 5-year local-regional failure rate is 3/40 (7.5%) for the group irradiated before surgery, and 39/135 (29%) for the historical controls managed by surgery alone (significance level = 0.015). The 5-year determinate disease-free survival is 27/38 (71%) for the patients irradiated before surgery, and 47/114 (41%) for the historical group of patients treated with surgery alone (significance level = 0.008).