Pucciarelli S, Friso M L, Toppan P, Fornasiero A, Carnio S, Marchiori E, Lise M
Clinica Chirurgica II, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Italy.
Ann Surg Oncol. 2000 Jan-Feb;7(1):38-44. doi: 10.1007/s10434-000-0038-5.
Adjuvant treatment for rectal cancer is still controversial. This study reports on overall survival and disease-free survival, toxicity, downstaging, and surgical morbidity in rectal cancer patients who received combined chemoradiation therapy followed by curative surgery.
Between 1993 and 1998, 51 patients (31 males and 20 females; median age, 60 years; range, 33-73 years) underwent chemoradiation therapy followed by radical surgery for middle and lower rectal adenocarcinoma. Criteria for giving preoperative radiotherapy (total 45 Gy in 25 fractions of 1.8 Gy/day for 5 weeks) and chemotherapy (5-fluorouracil 350 mg/m2/day and leucovorin 10 mg/m2/day, bolus on days 1-5 and 29-33) were an age younger than 75 years; an Eastern Cooperative Oncology Group performance status score of 0 to 2; and clinical preoperative stage II-III. Forty-three low anterior and eight abdominoperineal resections were performed. Median follow-up time was 29 (range, 3-63) months.
Although grade 3 to 4 toxicity occurred in 14 cases (27.4%), all patients completed the planned adjuvant therapy. At pathology, a complete response was found in eight (15.7%) cases. Of the remaining 43 cases, 22 were stage I, 12 were stage II, and 9 were stage III. Five-year actuarial disease-free survival and overall survival rates were 86.4% and 85.5%, respectively. Whereas no local recurrences were found, 4 patients had distant metastases. Three patients died (1 of cancer-related causes), 45 are alive and disease free, and 3 are alive with disease.
The combined preoperative chemoradiation approach used by us seems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required to confirm these preliminary results.
直肠癌的辅助治疗仍存在争议。本研究报告了接受联合放化疗后行根治性手术的直肠癌患者的总生存期、无病生存期、毒性反应、降期情况及手术并发症。
1993年至1998年间，51例患者（31例男性，20例女性；中位年龄60岁；范围33 - 73岁）接受了放化疗，随后对中低位直肠腺癌进行根治性手术。术前放疗（5周内每天1.8 Gy共25次，总量45 Gy）和化疗（5-氟尿嘧啶350 mg/m²/天和亚叶酸钙10 mg/m²/天，第1 - 5天和第29 - 33天静脉推注）的标准为年龄小于75岁；东部肿瘤协作组体能状态评分为0至2；临床术前分期为II - III期。进行了43例低位前切除术和8例腹会阴联合切除术。中位随访时间为29（范围3 - 63）个月。
尽管14例（27.4%）患者出现3至4级毒性反应，但所有患者均完成了计划的辅助治疗。病理检查发现8例（15.7%）患者完全缓解。其余43例中，22例为I期，12例为II期，9例为III期。5年精算无病生存率和总生存率分别为86.4%和85.5%。未发现局部复发，4例患者有远处转移。3例患者死亡（1例与癌症相关），45例患者存活且无病，3例患者带瘤存活。
我们采用的术前联合放化疗方法似乎可提高部分直肠癌患者的无病生存率和总生存率。然而，需要更长的随访时间来证实这些初步结果。
