Eble M J, Lehnert T, Treiber M, Latz D, Herfarth C, Wannenmacher M
Department of Radiotherapy, Kopfklinikum, Heidelberg, Germany.
Radiother Oncol. 1998 Nov;49(2):169-74. doi: 10.1016/s0167-8140(98)00124-8.
Late adverse effects (i.e. neuropathy, chronic bowel obstruction) limit the effective dose given in intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT). Initial results of a multi-modality treatment approach using moderate dose IORT and moderate dose EBRT are presented.
Thirty-one consecutive patients with recurrent rectal carcinomas had IORT and EBRT after complete (R0, n = 14) or incomplete resection (R1, n = 9; R2, n = 8). The mean [ORT dose was 13.7 Gy (range 12-20 Gy) supplemented with an EBRT dose of 41.4 Gy. Twenty-two patients had preoperative EBRT and 22 patients had concomitant chemotherapy (5-FU, Leucovorine).
After a median follow-up of 28 months, 16 patients had re-recurrent disease and 11 patients had died. Nine patients failed locally (four in-field, four marginal and one anastomotic re-recurrence), three combined with distant metastasis, resulting in overall and IORT infield local control rates of 71% and 87%, respectively. Distant metastases alone were found in seven patients. The 4-year overall and relapse-free survival rates were 58% and 48%, respectively. After incomplete resection the local failure rate increased (R0 21%, R1/2 35%) and the 4-year relapse-free survival rate decreased significantly (29% versus 71%) due to a markedly increased distant metastasis rate (53% versus 7%). Acute and late toxicities were not increased.
The combination of moderate dose IORT and EBRT is a safe and efficacious component in a multi-modality treatment approach.
迟发性不良反应（如神经病变、慢性肠梗阻）限制了术中放疗（IORT）和外照射放疗（EBRT）的有效剂量。本文介绍了采用中等剂量IORT和中等剂量EBRT的多模式治疗方法的初步结果。
31例连续性复发性直肠癌患者在根治性（R0，n = 14）或非根治性切除（R1，n = 9；R2，n = 8）后接受了IORT和EBRT。IORT的平均剂量为13.7 Gy（范围12 - 20 Gy），并补充EBRT剂量41.4 Gy。22例患者接受了术前EBRT，22例患者接受了同步化疗（5-氟尿嘧啶、亚叶酸钙）。
中位随访28个月后，16例患者出现疾病复发，11例患者死亡。9例患者局部复发（4例野内复发、4例边缘复发和1例吻合口复发），3例合并远处转移，总体局部控制率和IORT野内局部控制率分别为71%和87%。仅7例患者出现远处转移。4年总生存率和无复发生存率分别为58%和48%。非根治性切除后局部失败率增加（R0为21%，R1/2为35%），4年无复发生存率显著降低（29%对71%），原因是远处转移率明显增加（53%对7%）。急性和迟发性毒性未增加。
中等剂量IORT和EBRT联合应用是多模式治疗方法中一种安全有效的组成部分。
