Elsaleh H, Joseph D, Levitt M, House A, Robbins P
Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Aust N Z J Surg. 1999 Oct;69(10):737-42. doi: 10.1046/j.1440-1622.1999.01677.x.
The aim of the present study was to investigate the effectiveness and toxicity of pre-operative chemoradiation in locally advanced rectal cancer (T3-T4).
Forty-seven patients were assessed (38 T3 and nine T4 tumours). Pre-operative pelvic radiotherapy was delivered in four fields, 45 Gy in 25 fractions over 5 weeks. Bolus 5-fluorouracil (5-FU) was delivered 500 mg/m2 on days 1, 2, 3 and days 22, 23, 24. Total mesorectal excision of the rectal tumour either by anterior or abdomino-perineal resection was planned at 4-6 weeks from completion of pre-operative treatment. Response to therapy was assessed by fresh macroscopic measurement of the surgical specimen.
All patients undergoing chemoradiation completed therapy as planned, with no treatment-related interruptions. The regimen had a low acute toxicity profile with an estimated 50% or greater response in 38 out of 47 patients (four patients had complete responses). Forty-three (97%) of 44 patients who underwent surgery were operable. Patients who were operated on between 4 and 7 weeks had a statistically better response then those who were operated on after 7 weeks (P = 0.013; Fisher's exact test). Eight of 10 patients who were considered to be inoperable prior to the treatment underwent total mesorectal excision with negative radial margins. Anastomotic leakage occurred in four patients (9%); one required surgical intervention. Wound infection occurred in three patients (6%); one patient required re-exploration for haemorrhage. Delayed complications occurred in three patients (6%); one requiring surgery for a stomal stricture. After a median follow-up of 20 months, two patients (4%) had developed local recurrence.
The pre-operative chemoradiation regimen employed had a low acute toxicity profile and all patients completed therapy. The majority of patients considered inoperable prior to receiving this treatment underwent successful excision. Appropriately fractionated pre-operative chemoradiotherapy is a reasonable option in this disease and deserves further evaluation.
本研究旨在探讨术前放化疗在局部晚期直肠癌（T3 - T4）中的有效性和毒性。
评估了47例患者（38例T3肿瘤和9例T4肿瘤）。术前盆腔放疗采用四野照射，5周内分25次给予45 Gy。在第1、2、3天以及第22、23、24天给予推注5 - 氟尿嘧啶（5 - FU），剂量为500 mg/m²。计划在术前治疗完成后4 - 6周通过前路或腹会阴联合切除术对直肠肿瘤进行全直肠系膜切除。通过对手术标本进行新鲜大体测量来评估治疗反应。
所有接受放化疗的患者均按计划完成治疗，无治疗相关中断。该方案急性毒性较低，47例患者中有38例（4例完全缓解）估计反应率达到50%或更高。44例接受手术的患者中有43例（97%）可进行手术。在4至7周内接受手术的患者反应在统计学上优于7周后接受手术的患者（P = 0.013；Fisher精确检验）。10例治疗前被认为不可手术的患者中有8例进行了全直肠系膜切除，切缘阴性。4例患者（9%）发生吻合口漏；1例需要手术干预。3例患者（6%）发生伤口感染；1例患者因出血需要再次探查。3例患者（6%）出现延迟并发症；1例因造口狭窄需要手术。中位随访20个月后，2例患者（4%）出现局部复发。
所采用的术前放化疗方案急性毒性较低，所有患者均完成治疗。大多数在接受该治疗前被认为不可手术的患者成功进行了切除。适当分割的术前放化疗是该疾病的合理选择，值得进一步评估。
