Calvo Felipe A, Gómez-Espí Marina, Díaz-González Juan A, Alvarado Arnaldo, Cantalapiedra Rocío, Marcos Pilar, Matute Raúl, Martínez Nuria E, Lozano Miguel A, Herranz Rafael
Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Radiother Oncol. 2002 Feb;62(2):201-6. doi: 10.1016/s0167-8140(01)00477-7.
To analyze early results of a single institution experience using adjuvant intraoperative electron radiation therapy (IOERT) presacral boost in locally advanced rectal cancer following preoperative chemoradiation.
In a 63 month period (March 1995-June 2000), 100 consecutive T(3-4)N(x) rectal cancer patients were treated with preoperative chemoradiation (45-50 Gy plus oral Tegafur or 5-Fluorouracil continuous intravenous infusion), radical surgery and IOERT presacral boost (mean dose, 12.5 Gy; range, 10-15 Gy). Adjuvant chemotherapy (5-FU-leucovorin: 4-6 cycles) was given to 52 patients. The median age was 63 years, and 39 patients were >or=70 years old (65 males). Clinical staging was performed with computed tomography (94%) and/or endorectal ultrasound (71%) categorizing 90 cT(3), 10 cT(4), 20 cN(x), and 36 cN(+). Abdomino-perineal resection was performed in 41 cases.
The IOERT cancellation rate was 6%. With a median follow-up of 23 months in IOERT treated patients, three developed pelvic recurrence: one anastomotic and one in the posterior vaginal wall (simultaneously with distant metastatic disease); and one presacral (in-field IOERT) as the only site of initial failure. Distant metastasis has been observed in 14 patients (exceptionally in pT(0-1) downstaged patients: 1/20; 5%). Overall treatment tolerances, including neoadjuvant and surgical segments, were acceptable. The actuarial 4-year estimations of local control, disease-free and overall survival are 94, 75 and 65%, respectively.
IOERT electron boost to the presacral region is feasible to integrate systematically in the intensive combined treatment of locally advanced rectal cancer, including neoadjuvant chemoradiation segment. Topography of pelvic recurrences identified 2/3 relapses located in non-IOERT boosted anatomic intrapelvic sites: posterior vaginal wall and anastomotic suture. Presacral recurrence in locally advanced rectal cancer seems to be of low incidence, in a non-subspecialized academic surgical practice coordinated with a multidisciplinary oncology evaluation context, if an IOERT boost is included as a component of treatment together with preoperative chemoradiation.
分析在术前放化疗后，对局部晚期直肠癌患者采用术中骶前追加电子线放疗（IOERT）的单机构早期治疗结果。
在63个月期间（1995年3月至2000年6月），连续100例T(3 - 4)N(x)期直肠癌患者接受了术前放化疗（45 - 50 Gy加口服替加氟或5 - 氟尿嘧啶持续静脉输注）、根治性手术及术中骶前追加放疗（平均剂量12.5 Gy；范围10 - 15 Gy）。52例患者接受了辅助化疗（5 - 氟尿嘧啶 - 亚叶酸：4 - 6周期）。患者中位年龄为63岁，39例患者年龄≥70岁（65例男性）。通过计算机断层扫描（94%）和/或直肠内超声（71%）进行临床分期，其中90例为cT(3)，10例为cT(4)，20例为cN(x)，36例为cN(+)。41例行腹会阴联合切除术。
IOERT取消率为6%。接受IOERT治疗的患者中位随访23个月，3例出现盆腔复发：1例吻合口复发，1例同时伴有远处转移疾病的阴道后壁复发；1例骶前复发（在IOERT照射野内）为初始失败的唯一部位。14例患者出现远处转移（在pT(0 - 1)降期患者中罕见：1/20；5%）。包括新辅助治疗和手术阶段在内的总体治疗耐受性良好。局部控制、无病生存率和总生存率的4年精算估计分别为94%、75%和65%。
在局部晚期直肠癌的强化综合治疗中，包括新辅助放化疗阶段，系统地整合骶前区域的IOERT电子线追加放疗是可行的。盆腔复发部位显示2/3的复发位于未接受IOERT追加放疗的盆腔内解剖部位：阴道后壁和吻合口缝线处。在与多学科肿瘤评估相结合的非专科临床手术实践中，如果将IOERT追加放疗作为治疗的一部分与术前放化疗一起应用，局部晚期直肠癌的骶前复发似乎发生率较低。
