Gretschel S, Rau B, Wust P, Riess H, Schlag P M
Robert-Rössle-Klinik, Klinik für Chirurgie und Chirurgische Onkologie, Humboldt-Universität zu Berlin.
Strahlenther Onkol. 2000 Oct;176(10):448-51. doi: 10.1007/pl00002308.
With the intention to achieve tumor reduction and thereby increase R0-resection rate, preoperative radiochemotherapy is increasingly applied in locally advanced rectum cancer. Along with the advantages of prior therapy, a delay of surgical treatment occurs which might despite continuing therapy give way to local tumor progression or metastatic disease.
Since 1993 we have treated locally advanced rectum carcinomas by preoperative radiotherapy according to a preoperative study protocol. We analyzed the incidence of local tumor progression or metastases during the 12 weeks of preoperative treatment. Hundred and fifteen patients with histologically proven primary rectum carcinoma without evidence of regional or distant metastases and endosonographically determined infiltration depth of stage T3 or more underwent preoperative radiochemotherapy between 3/1993 and 10/1999. Hundred and eight patients (88 times uT3 and (20 times uT4) have been operated and examined afterwards with respect to response to prior treatment. Before and after preoperative therapy, endorectal ultrasound was performed to evaluate local response. Distant metastatic manifestations were excluded by radiography and ultrasound scanning.
A reduction of the infiltration depth was observed in 55 patients (51%). Tumor size remained unchanged in 50 patients (46%). Only 3 patients (3%) showed tumor growth in histological assessment. Fifty-seven patients (53%) showed no change in lymph node status after preoperative therapy, whereas lymph node metastases were detected in 11 patients (10%) who were judged uN0 preoperatively. We discovered metastases in 6 patients (6%) after preoperative therapy.
During preoperative therapy, tumor progress is not entirely evitable. Considering the lack of precision in pretherapeutic staging diagnostics, we conclude that delays due to therapeutic regimen are responsible for prognostic disadvantage in only a small number of patients.
为实现肿瘤缩小从而提高R0切除率，术前放化疗在局部晚期直肠癌中的应用日益增多。随着前期治疗的优势，手术治疗出现延迟，这可能导致尽管持续治疗仍出现局部肿瘤进展或转移性疾病。
自1993年以来，我们根据术前研究方案对局部晚期直肠癌患者进行术前放疗。我们分析了术前治疗12周期间局部肿瘤进展或转移的发生率。1993年3月至1999年10月期间，115例经组织学证实为原发性直肠癌且无区域或远处转移证据、经腔内超声确定浸润深度为T3期或更高的患者接受了术前放化疗。108例患者（88例为uT3期，20例为uT4期）术后接受了手术并检查了对前期治疗的反应。术前治疗前后均进行腔内超声检查以评估局部反应。通过X线摄影和超声扫描排除远处转移表现。
55例患者（51%）浸润深度减小。50例患者（46%）肿瘤大小未变。组织学评估中仅3例患者（3%）肿瘤生长。57例患者（53%）术前治疗后淋巴结状态无变化，而术前判断为uN0的11例患者（10%）检测到淋巴结转移。术前治疗后我们发现6例患者（6%）出现转移。
术前治疗期间，肿瘤进展并非完全可避免。考虑到治疗前分期诊断缺乏精确性，我们得出结论，治疗方案导致的延迟仅在少数患者中造成预后不良。
