Gérard J P, Chapet O, Romestaing P, Favrel V, Barbet N, Mornex F
Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon-Sud, Pierre-Bénite.
Gastroenterol Clin Biol. 2000 Apr;24(4):430-5.
To study retrospectively the relapse rate, the functional results and the survival rate in patients with rectal carcinoma treated with local excision and adjuvant radiotherapy.
Between 1980 and 1995, 43 patients were treated. All cancers were infiltrating tumours except 4 high grade dysplasias with positive margins. The pT classification was: pT1 (n=34), pT2 (n=4), pT3 (n=1). In 4 cases the depth of penetration of the tumor into the bowel wall was not evaluable. The endo-anal excision was performed by surgery (n=20) or by endoscopy (n=23). Only the tumor bed was irradiated in 35 cases (contact x-ray therapy: 30, interstitial iridium implant: 5) and in 8 cases the whole rectum was irradiated with external beam radiotherapy (+/- endocavitary irradiation).
Median follow-up was 72 months. Four malignant relapses were observed (local: 1, perirectal lymphatic: 2, distant metastasis: 1). The overall 5- and 10-year survival rates were 80 and 68%, respectively. A total of 41 patients preserved a normal sphincter (95%). The anal function was evaluated as excellent or good in all the cases. No severe radiation toxicity was observed.
Small rectal carcinomas T1 N0 can be effectively treated in most cases by local excision and postoperative radiation therapy. A close multidisciplinary collaboration is necessary to achieve an optimal result.
回顾性研究局部切除联合辅助放疗治疗直肠癌患者的复发率、功能结果和生存率。
1980年至1995年间，对43例患者进行了治疗。除4例切缘阳性的高级别发育异常外，所有癌症均为浸润性肿瘤。pT分类为：pT1（n = 34），pT2（n = 4），pT3（n = 1）。4例患者肿瘤侵犯肠壁的深度无法评估。经肛门切除通过手术进行（n = 20）或通过内镜进行（n = 23）。35例仅对肿瘤床进行照射（接触X线治疗：30例，组织间铱植入：5例），8例采用外照射放疗对整个直肠进行照射（±腔内照射）。
中位随访时间为72个月。观察到4例恶性复发（局部：1例，直肠周围淋巴结：2例，远处转移：1例）。5年和10年总生存率分别为80%和68%。共有41例患者保留了正常括约肌（95%）。所有病例的肛门功能评估为优秀或良好。未观察到严重的放射毒性。
大多数情况下，T1 N0期小直肠癌可通过局部切除和术后放疗有效治疗。需要多学科密切合作以取得最佳结果。
