Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy
Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy
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DOI：
10.1016/j.radonc.2003.12.006
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发表时间：
2004-07-01
影响因子：
5.7
通讯作者：
Kukolowicz, P
中科院分区：
文献类型：
--
作者：
Bujko, K;Nowacki, MP;Kukolowicz, P
背景和目的：目的是验证术前常规分次放化疗与术前短期放疗相比是否在保肛方面具有优势。患者和方法：可切除的T3-4直肠癌患者，无括约肌浸润，病变可进行直肠指检，随机分为：术前5 x 5戈伊短期放疗，随后在7天内进行全直肠系膜切除术（TME）或放化疗，总剂量为50.4戈伊（每次1.8戈伊），同时进行两个疗程的5-氟尿嘧啶和甲酰四氢叶酸推注，4-6周后进行TME。外科医生有义务根据手术的肿瘤状态的类型在surgery.Results：在1999年和2002年之间，316例患者从19个机构参加。5 x 5戈伊组和放化疗组的括约肌保留率分别为61%和58%，P = 0.57。与短期方案相比，接受放化疗的患者的肿瘤平均小1.9 cm（P < 0.001）。对于接受保肛手术的患者，外科医生通常遵循根据肿瘤缩小量身定制切除术的规则;两个随机化组的中位远端肠边缘相同（2 cm）。然而，在化放疗组，5例患者接受腹会阴切除术，尽管临床完全respons.Conclusions：尽管显着缩小，化放疗并没有导致增加括约肌保留率与短期术前放疗相比。外科医生的决定是主观的，至少在临床完全反应者中是基于治疗前的肿瘤体积。(C)2004爱思唯尔爱尔兰有限公司保留所有权利。
Background and purpose: The aim was to verify whether preoperative conventionally fractionated chemoradiation offers an advantage in sphincter preservation in comparison with preoperative short-term irradiation. Patients and methods:Patients with resectable T3-4 rectal carcinoma without sphincters' infiltration and with a lesion accessible to digital rectal examination were randomised into: preoperative 5 x 5 Gy short-term irradiation with subsequent total mesorectal excision (TME) performed within 7 days or chemoradiation to a total dose of 50.4 Gy (1.8 Gy per fraction) concomitantly with two courses of bolus 5-fluorouracil and leucovorin followed by TME after 4-6 weeks. Surgeons were obliged to base the type of operation on the tumour status at the time of surgery.Results: Between 1999 and 2002, 316 patients from 19 institutions were enrolled. The sphincter preservation rate was 61% in the 5 x 5 Gy arm and 58% in the radiochemotherapy arm, P = 0.57. The tumour was on average 1.9 cm smaller (P < 0.001) among patients treated with chemoradiation compared with short-term schedule. For patients who underwent sphincter-preserving procedure, the surgeons generally followed the rule of tailoring the resection according to tumour downsizing; the median distal bowel margin was identical (2 cm) for both randomised groups. However, in the chemoradiation group, five patients underwent abdominoperineal resection despite clinical complete response.Conclusions: Despite significant downsizing, chemoradiation did not result in increased sphincter preservation rate in comparison with short-term preoperative radiotherapy. The surgeons' decisions were subjective and based on pre-treatment tumour volume at least in clinical complete responders. (C) 2004 Elsevier Ireland Ltd. All rights reserved.