Grann A, Feng C, Wong D, Saltz L, Paty P P, Guillem J G, Cohen A M, Minsky B D
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2001 Mar 15;49(4):987-95. doi: 10.1016/s0360-3016(00)01529-7.
To determine the acute toxicity, outcome, and sphincter preservation rates in patients with clinically resectable uT3 adenocarcinoma of the rectum treated with preoperative combined modality therapy.
A total of 72 patients were treated from 12/90-7/98 with preoperative 50.4 Gy plus 2 cycles of concurrent 5-fluorouracil (5-FU) and leucovorin (LV) bolus daily x 5 followed by sharp or total mesorectal excision and 4 cycles of postoperative 5-FU and LV.
Individual Grade 3+ toxicities during preoperative therapy included diarrhea, 11%; bowel movements, 9%; leukopenia, 18%; tenesmus, 1%; and thrombocytopenia, 1%. Total Grade 3+ toxicity was 28%. The pathologic complete response (CR) rate was 13%, and an additional 9% had a clinical CR for a total CR rate of 22%. Of the 35 patients who were judged clinically by their operating surgeon to require an abdominoperineal resection (APR) and were therefore treated with the goal of sphincter preservation, 89% were able to undergo sphincter-preserving surgery. Of the 21 patients eligible for analysis, 81% had good to excellent sphincter function. The 3-year actuarial patterns of failure were 2% local, 8% abdominal, and 13% distant. The 3-year actuarial survival was 95%.
Our data confirm our preliminary reports of encouraging rates of acute toxicity, local control, survival, sphincter preservation and function with preoperative combined modality therapy. It is an alternative approach for the treatment of uT3 clinically resectable rectal cancer.
确定接受术前综合治疗的临床可切除直肠uT3腺癌患者的急性毒性、治疗结果及括约肌保留率。
1990年12月至1998年7月，共有72例患者接受了术前50.4 Gy放疗，同时每日给予2个周期的5-氟尿嘧啶（5-FU）和亚叶酸钙（LV）推注，共5天，随后进行锐性或全直肠系膜切除术，并在术后给予4个周期的5-FU和LV治疗。
术前治疗期间个体3级及以上毒性反应包括腹泻，11%；排便异常，9%；白细胞减少，18%；里急后重，1%；血小板减少，1%。3级及以上总毒性反应为28%。病理完全缓解（CR）率为13%，另有9%达到临床CR，总CR率为22%。35例经手术医生临床判断需要行腹会阴联合切除术（APR）并以保留括约肌为治疗目标的患者中，89%能够接受保留括约肌的手术。在21例符合分析条件的患者中，81%的患者括约肌功能良好至优秀。3年精算失败模式为局部2%，腹部8%，远处13%。3年精算生存率为95%。
我们的数据证实了我们之前的初步报告，即术前综合治疗在急性毒性、局部控制、生存、括约肌保留及功能方面的效果令人鼓舞。它是治疗临床可切除直肠uT3癌的一种替代方法。
