Bujko K, Nowacki M P, Oledzki J, Sopyło R, Skoczylas J, Chwaliński M
Department of Colorectal Cancer, The Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
Acta Oncol. 2001;40(5):593-601. doi: 10.1080/028418601750444132.
This report is based on a series of 108 patients with clinically staged T2 (9), T3 (94) and T4 (5) rectal cancer treated with preoperative irradiation with 25 Gy, 5 Gy per fraction given for one week. In 77% of patients. the tumour was located within 7 cm of the anal verge and in 15% the anal canal was involved. Surgery was usually undertaken during the week after irradiation. For low tumours, total mesorectal excision was performed, and for middle and upper cancers, the whole circumference of the mesorectum was excised at least 2 cm below the lower pole of a tumour. Tumour was resected in 103 patients, and sphincter-preserving surgery was performed in 73% of them. In the subgroup where the tumour was located higher than 4 cm from the anal verge, sphincter-preserving surgery was performed in 95%. The follow-up period ranged from 10 to 49 months, with a median of 25 months. Local recurrences were observed in 4% of patients. Anorectal dysfunction caused impairment of social life in 40% of patients and 18% admitted that their quality of life was seriously affected however, none of them stated that they would have preferred a colostomy. These preliminary data suggest that following high dose per fraction short-term preoperative radiotherapy a high rate of sphincter-preserving surgery can be reached, with acceptable anorectal function and an acceptable rate of local failure and late complications. The results of our own data and literature review indicate the need for a randomized clinical trial comparing high dose per fraction preoperative radiotherapy with immediate surgery with conventional preoperative radiochemotherapy with delayed surgery.
本报告基于108例临床分期为T2（9例）、T3（94例）和T4（5例）的直肠癌患者，这些患者接受了术前放疗，剂量为25 Gy，每周5 Gy，每次1次。77%的患者肿瘤位于距肛缘7 cm以内，15%的患者肛管受累。手术通常在放疗后一周内进行。对于低位肿瘤，行全直肠系膜切除术；对于中高位肿瘤，在肿瘤下缘至少2 cm以下切除直肠系膜全周。103例患者切除了肿瘤，其中73%的患者进行了保肛手术。在肿瘤距肛缘高于4 cm的亚组中，95%的患者进行了保肛手术。随访期为10至49个月，中位随访期为25个月。4%的患者出现局部复发。40%的患者因肛门直肠功能障碍影响社交生活，18%的患者承认其生活质量受到严重影响，然而，他们中没有人表示宁愿接受结肠造口术。这些初步数据表明，在采用高剂量短程术前放疗后，可以实现较高的保肛手术率，肛门直肠功能可接受，局部失败率和晚期并发症发生率也可接受。我们自己的数据和文献综述结果表明，需要进行一项随机临床试验，比较高剂量短程术前放疗后立即手术与传统术前放化疗后延迟手术的疗效。
