Mohiuddin M, Hayne M, Regine W F, Hanna N, Hagihara P F, McGrath P, Marks G M
Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, KY 40536-0293, USA.
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1075-80. doi: 10.1016/s0360-3016(00)00732-x.
To evaluate the prognostic significance of postchemoradiation pathologic stage and implications for further therapy following preoperative chemoradiation and surgery for advanced/recurrent rectal cancer.
Seventy-seven patients with advanced (fixed or tethered T4) or recurrent rectal cancer were treated with preoperative chemoradation followed by surgical resection of disease. Chemotherapy consisted of either of bolus 5-FU 500 mg/m(2) per day or continuous venous infusion 225 mg/m(2) per day for the duration of radiation. Radiation therapy was planned to be delivered to the whole pelvis to a dose of 45 Gy followed by a boost to the area of the tumor of 5-15 Gy. Total radiation doses ranged from 40 to 63 Gy with a median of 55.8 Gy. Surgical resection was then carried out 6-10 weeks following the completion of treatment (median, 7 weeks). Twenty-eight patients underwent abdominoperineal resection and and 49 patients had sphincter-sparing surgical procedures. None of the patients received postoperative chemotherapy. Follow-up in these patients ranges from 1 year to 8 years with a median of 3 years.
Significant downstaging of disease was observed with 12/77 (16%) having no residual disease(pT0) and 13% (10/77) found to have pT1-2, N0 disease, 31% (24/77) with pT3-4, N0 and 40% (31/77) for pT0-4, N1-2 cancers. Survival by pathologic stage was 100% for pT0-2, N0 cancers, 80% for pT3-4, N0 and 73% for pTx, N1-2. Local recurrence of disease was observed in 0% of patients with pT0-2, N0 as compared with 13% (3/24) in pT3-4, N0 and 16% (5/31) in pT0-4, N1-2 patients.
Downstaging following preoperative chemoradiation is a significant prognostic factor. Patients with pT0, T1, or T2 disease have an excellent prognosis and are unlikely to fail locally or with systemic disease. However, patient with T3/T4 or N+ disease may benefit from further adjuvant chemotherapy.
评估术前放化疗联合手术治疗晚期/复发性直肠癌后，放化疗后病理分期的预后意义及对进一步治疗的影响。
77例晚期（固定或粘连性T4）或复发性直肠癌患者接受术前放化疗，随后行手术切除病灶。化疗方案为在放疗期间每天静脉推注5-氟尿嘧啶（5-FU）500mg/m²或持续静脉输注225mg/m²。放疗计划全盆腔照射剂量为45Gy，然后对肿瘤区域追加5-15Gy。总放疗剂量范围为40至63Gy，中位剂量为55.8Gy。治疗结束后6-10周（中位时间为7周）进行手术切除。28例患者接受了腹会阴联合切除术，49例患者接受了保留括约肌的手术。所有患者均未接受术后化疗。这些患者的随访时间为1年至8年，中位时间为3年。
观察到疾病明显降期，12/77（16%）患者无残留病灶（pT0），13%（10/77）患者为pT1-2、N0疾病，24/77（31%）患者为pT3-4、N0，31/77（40%）患者为pT0-4、N1-2癌症。pT0-2、N0癌症患者的病理分期生存率为100%，pT3-4、N0患者为80%，pTx、N1-2患者为73%。pT0-2、N0患者的局部复发率为0%，而pT3-4、N0患者为13%（3/24），pT0-4、N1-2患者为16%（5/31）。
术前放化疗后的降期是一个重要的预后因素。pT0、T1或T2疾病患者预后良好，局部或全身疾病进展的可能性较小。然而，T3/T4或N+疾病患者可能从进一步的辅助化疗中获益。
