Cionini L, Scandolaro L, Genovesi D
Universitàdegli Studi di Pisa, Facoltàdi Medicina Via Roma, 67 56100 Pisa.
Ann Ital Chir. 2001 Sep-Oct;72(5):573-7.
In the last 40 years, radiotherapy as gained a major role in the curative treatment of rectal carcinoma. Based on a reported incidence of local failure after surgery between 15% and 50%, in patients with T3-4 rectal cancer, postoperative radiation has been proposed in this group of patients. However, postoperative radiotherapy results associated with a relatively high incidence of acute and late toxicity and the reported improvement in local control attained statistical significance only in the MRC randomized trial. A recent publication suggests that postoperative radiation should probably be reserved to the subgroup of pT3 patients with unfavourable features. Postoperative radiation therapy is considered also for patients with G1-2 carcinoma treated with local excision, who do not show lymphatic or venous invasion, and for those with pT2 stage or pT1 carcinoma with involved resection margins.
在过去40年里，放射治疗在直肠癌的根治性治疗中发挥了重要作用。根据报道，T3-4期直肠癌患者术后局部复发率在15%至50%之间，因此建议对该组患者进行术后放疗。然而，术后放疗会导致相对较高的急慢性毒性发生率，且仅在MRC随机试验中，所报道的局部控制改善才具有统计学意义。最近的一篇文献表明，术后放疗可能应仅保留给具有不良特征的pT3亚组患者。对于接受局部切除且未出现淋巴管或静脉侵犯的G1-2级癌患者，以及切缘受累的pT2期或pT1癌患者，也考虑进行术后放疗。
