Birnbaum E H, Ogunbiyi O A, Gagliardi G, Fry R D, Myerson R J, Kodner I J, Fleshman J W
Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Dis Colon Rectum. 1999 Jun;42(6):727-33; discussion 733-5. doi: 10.1007/BF02236926.
The aim of this study was to identify factors predictive of recurrence of rectal tumors treated with combined external and endocavitary radiation.
Seventy-two patients with rectal cancer were evaluated clinically and with transrectal ultrasound before combined external and endocavitary radiation. Ideal lesions were moderately differentiated, mobile, not ulcerated, <3 cm in diameter, and <12 cm from the anal verge. External radiation (4,500 cGy) was given during five weeks followed by endocavitary radiation (3,000 cGy x 2). Median follow-up was 31 (range, 7-93) months.
Pretreatment transrectal ultrasound stages were uT1 (6 patients), uT2 (27 patients), and uT3 (39 patients). Clinical evaluation identified 26 ideal and 46 nonideal tumors. Overall recurrence was 36 percent; mean time to recurrence was 12 months. Ideal lesions recurred less than nonideal (15 vs. 48 percent; P = 0.01). Mobile lesions recurred less than tethered lesions (26 vs. 52 percent; P = 0.048). Transrectal ultrasound stage was predictive of recurrence (0 percent uT1, 22 percent uT2, and 51 percent uT3; P = 0.015). Surgery was possible in 14 of 17 patients with pelvic recurrence only; 11 patients (65 percent) had curative surgery. Distant metastases occurred in nine patients; all had pelvic recurrences, and six died of disease.
Patients with uT3 or nonideal rectal cancers should not be offered combined external and endocavitary radiation for cure. Transrectal ultrasound stage is the only independent predictor of recurrence.
本研究旨在确定经外照射与腔内照射联合治疗的直肠肿瘤复发的预测因素。
72例直肠癌患者在接受外照射与腔内照射联合治疗前进行了临床评估和经直肠超声检查。理想病变为中度分化、可活动、无溃疡、直径<3 cm且距肛缘<12 cm。外照射（4500 cGy）在5周内进行，随后腔内照射（3000 cGy×2）。中位随访时间为31（范围7 - 93）个月。
治疗前经直肠超声分期为uT1（6例患者）、uT2（27例患者）和uT3（39例患者）。临床评估确定26例为理想肿瘤，46例为非理想肿瘤。总体复发率为36%；平均复发时间为12个月。理想病变的复发率低于非理想病变（15%对48%；P = 0.01）。可活动病变的复发率低于固定病变（26%对52%；P = 0.048）。经直肠超声分期可预测复发（uT1为0%，uT2为22%，uT3为51%；P = 0.015）。仅17例盆腔复发患者中有14例可行手术；11例患者（65%）接受了根治性手术。9例患者发生远处转移；均有盆腔复发，6例死于疾病。
uT3期或非理想直肠癌患者不应接受外照射与腔内照射联合治疗以治愈疾病。经直肠超声分期是复发的唯一独立预测因素。
