Gunderson L L
Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA.
Acta Oncol. 1999;38(1):7-21. doi: 10.1080/028418699431753.
Combined modality chemoirradiation is commonly used as a component of treatment in combination with maximum resection for both high-risk resectable and locally advanced primary or recurrent rectal cancers. With surgically resected but high-risk rectal cancers, postoperative chemoirradiation has been shown to improve both disease control (local and distant) and survival (disease-free and overall) and was recommended as standard adjuvant treatment at the 1990 National Institute of Health (NIH) Consensus Conference on Adjuvant treatment for patients with rectal and colon cancers. Subsequent intergroup trials are being conducted to help define optimal combinations of postoperative chemoirradiation for resected high-risk rectal cancers and to test sequencing issues of preoperative versus postoperative chemoirradiation. With locally unresectable primary or recurrent colorectal cancers, standard therapy with surgery, external beam irradiation (EBRT) and chemotherapy is often unsuccessful. When intraoperative electron irradiation (IOERT) is combined with standard treatment, local control and survival appear to be improved in separate analyses from the Mayo Clinic and the Massachusetts General Hospital (MGH). However, routine use of systemic therapy is also needed as a component of treatment, in view of high rates of systemic failure.
联合放化疗通常作为高风险可切除和局部晚期原发性或复发性直肠癌最大程度切除联合治疗的一部分。对于手术切除但具有高风险的直肠癌，术后放化疗已被证明可改善疾病控制（局部和远处）及生存率（无病生存率和总生存率），并在1990年国立卫生研究院（NIH）关于直肠癌和结肠癌辅助治疗的共识会议上被推荐为标准辅助治疗。随后正在进行组间试验，以帮助确定切除的高风险直肠癌术后放化疗的最佳组合，并测试术前与术后放化疗的序贯问题。对于局部不可切除的原发性或复发性结直肠癌，手术、外照射放疗（EBRT）和化疗的标准治疗往往不成功。当术中电子照射（IOERT）与标准治疗相结合时，梅奥诊所和麻省总医院（MGH）的单独分析显示局部控制和生存率似乎有所提高。然而，鉴于全身衰竭发生率较高，常规使用全身治疗也需要作为治疗的一部分。
