Mannaerts G H, Martijn H, Crommelin M A, Stultiëns G N, Dries W, van Driel O J, Rutten H J
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):297-308. doi: 10.1016/s0360-3016(99)00212-6.
Treatment results for locally recurrent rectal cancers are poor. This is a result of the fact that surgery is hampered due to the severance of the anatomical planes during the primary procedure and that radiotherapy is limited by normal tissue tolerance, especially after previous irradiation. This paper describes the results of a combined treatment modality in this patient group.
From 1994 to 1998, 37 patients with locally recurrent rectal cancer, but without distant metastatic disease, received a combined treatment consisting of 50.4 Gy preoperative irradiation or, in case of previous radiotherapy, 30 Gy reirradiation or no irradiation, followed by radical surgery and intraoperative electron beam radiotherapy boost.
Fifteen patients received a radical resection (R0), eight a microscopic irradical resection (R1), and 14 a macroscopic irradical resection (R2). The overall 3-year local control (LC), disease-free survival (DFS), and overall survival rates were 60%, 32%, and 58% respectively. Radicality of resection (R0/R1 vs. R2) turned out to be the significant factor for improved survival (p < 0.05), DFS (p = 0.0008), and LC (p = 0.01). Preoperative (re-)irradiation is the other significant factor in survival (p = 0.005) and DFS (p = 0.001) and was almost significant for LC (p = 0.08). After external beam radiation therapy (EBRT) a significantly higher resection rate was obtained (R0/R1 vs. R2 p = 0.001). Symptomatic peripheral local recurrences have a significantly worse prognosis and higher rate of R2-resection (p = 0.0005).
Centralization of locally recurrent rectal cancer patients enabled the development of an aggressive multimodality treatment, which in turn led to promising results. Distant failure is still a drawback.
局部复发性直肠癌的治疗效果较差。这是由于初次手术时解剖层面的分离阻碍了手术进行，且放疗受到正常组织耐受性的限制，尤其是在先前接受过放疗的情况下。本文描述了该患者群体联合治疗模式的结果。
1994年至1998年，37例局部复发性直肠癌患者，但无远处转移疾病，接受了联合治疗，包括50.4 Gy术前放疗，或者在先前接受过放疗的情况下，进行30 Gy再放疗或不放疗，随后进行根治性手术和术中电子束放疗增敏。
15例患者接受了根治性切除（R0），8例接受了镜下非根治性切除（R1），14例接受了肉眼非根治性切除（R2）。总体3年局部控制率（LC）、无病生存率（DFS）和总生存率分别为60%、32%和58%。切除的根治性（R0/R1与R2）被证明是提高生存率（p < 0.05）、DFS（p = 0.0008）和LC（p = 0.01）的重要因素。术前（再）放疗是生存率（p = 0.005）和DFS（p = 0.001）的另一个重要因素，对LC几乎有显著影响（p = 0.08）。在体外放射治疗（EBRT）后，获得了显著更高的切除率（R0/R1与R2，p = 0.001）。有症状的外周局部复发预后明显更差，R2切除率更高（p = 0.0005）。
局部复发性直肠癌患者的集中治疗使得积极的多模式治疗得以开展，进而带来了有希望的结果。远处转移仍然是一个缺点。
