Morganti A G, Santoni R, Osti M F
Cattedra di Radioterapia, Istituto di Radiologia, UniversitàCattolica del S. Cuore, Roma.
Ann Ital Chir. 2001 Sep-Oct;72(5):585-94.
Patients with locally recurrent rectal carcinoma have an unfavourable prognosis for the high incidence of distant metastases, the infrequent feasibility of radical surgical resection, and, in these last cases, the high incidence of re-recurrences. Based on the low resectability rate of pelvic recurrences, the clear impact of tumor diameter on resectability and outcome, and the documented possibility to achieve a significant tumor downstaging and downsizing with the use of concurrent chemoradiation, it is evident that the most promising treatment several authors have considered concurrent chemoradiation followed, if feasible, by radical resection. Furthermore, based on the high local and distant failure rate after surgery, the utilization of intraoperative radiation therapy (IORT) and adjuvant chemotherapy seems justified. Some published comparisons between patients treated with and without IORT seems to suggest the possible improvement in both local control and survival in these patients. Particularly interesting issues in this field are: 1) the definition of the most effective treatment modality (both in terms of radiation dose, fractionation and techniques, and drugs to be used concurrently to radiotherapy); 2) the analysis of the prognostic impact of several factors, with the aim of designing and validating staging systems of local rectal recurrences; 3) the possibility to treat with relatively high doses also patients previously irradiated on the pelvis.
局部复发性直肠癌患者预后不佳，原因在于远处转移发生率高、根治性手术切除的可行性低，以及在这些晚期病例中，复发率高。鉴于盆腔复发的可切除率低、肿瘤直径对可切除性和预后的显著影响，以及已证实的使用同步放化疗可实现显著的肿瘤降期和缩小的可能性，显然，几位作者认为最有前景的治疗方法是同步放化疗，若可行，随后进行根治性切除。此外，基于手术后局部和远处高失败率，术中放疗（IORT）和辅助化疗的应用似乎是合理的。一些已发表的关于接受和未接受IORT治疗患者的比较似乎表明，这些患者的局部控制和生存率可能得到改善。该领域特别有趣的问题有：1）最有效治疗方式的定义（包括放疗剂量、分割方式和技术，以及与放疗同时使用的药物）；2）分析多种因素的预后影响，旨在设计和验证局部直肠癌复发的分期系统；3）对于先前接受过盆腔放疗的患者，也有可能给予相对高剂量的治疗。
