Mohiuddin Mohammed, Marks Gerald, Marks John
Department of Radiation Medicine, University of Kentucky Medical Center, Lexington 40536-0293, USA.
Cancer. 2002 Sep 1;95(5):1144-50. doi: 10.1002/cncr.10799.
The current study was conducted to assess the long-term results of reirradiation in patients with recurrent rectal carcinoma.
One hundred and three patients with recurrent adenocarcinoma of the rectum underwent reirradiation with concurrent 5-fluorouracil-based chemotherapy. The initial radiation dose to the pelvis ranged from 3000 to 7400 centigrays (cGy) with a median dose of 5040 cGy. The median time from initial treatment to recurrence was 19 months. Irradiation techniques consisted of two lateral fields with/without a posterior pelvic field to include recurrent tumor with a margin of 2-4 cm only. The reirradiation doses ranged from 1500 to 4920 cGy with a median dose of 3480 cGy. Total cumulative doses ranged from 7060 to 1080 cGy with a median total dose of 8580 cGy. After the reirradiation, 34 patients also underwent surgical resection for residual disease. Fourteen patients underwent pelvic exenteration, 11 patients underwent abdominoperineal resection, 4 patients underwent transanal transabdominal proctosigmoidectomy, 2 patients underwent full thickness local excision, and 3 patients underwent a Hartmann resection.
Follow-up ranged from 3 84 months with a median follow-up of 2 years. The median survival for the whole group was 26 months and the 5-year actuarial survival rate was 19%. The median interval and 5-year survival rate of patients undergoing surgical resection after reirradiation was 44 months and 22% compared with 14 months and 15% for patients treated with reirradiation only (P = 0.001). Treatment was generally well tolerated. Fifteen patients required a treatment break and early termination of treatment for Grade 3 and higher diarrhea, moist desquamation, or mucositis. Late complications were seen in 22 patients, including persistent severe diarrhea in 18 patients with 10 patients requiring long-term parental support, small bowel obstruction was seen in 15 patients, fistula formation in 4 patients, and coloanal stricture in 2 patients. There was no difference in incidence of acute or long-term complications by the total radiation dose delivered.
In patients with recurrent rectal carcinoma, high doses of reirradiation can be delivered with acceptable risks without prohibitive long-term side effects. Surgical salvage and long-term survival of patients are possible.
本研究旨在评估复发性直肠癌患者再次放疗的长期疗效。
103例复发性直肠腺癌患者接受了基于5-氟尿嘧啶的同步化疗再放疗。骨盆的初始放疗剂量为3000至7400厘戈瑞（cGy），中位剂量为5040 cGy。从初始治疗到复发的中位时间为19个月。放疗技术包括两个侧野，有或无后盆腔野，仅包括边缘为2 - 4 cm的复发性肿瘤。再次放疗剂量为1500至4920 cGy，中位剂量为3480 cGy。总累积剂量为7060至1080 cGy，中位总剂量为8580 cGy。再次放疗后，34例患者因残留病灶还接受了手术切除。14例患者接受了盆腔脏器清除术，11例患者接受了腹会阴联合切除术，4例患者接受了经肛门经腹直肠乙状结肠切除术，2例患者接受了全层局部切除术，3例患者接受了哈特曼切除术。
随访时间为3至84个月，中位随访时间为2年。全组的中位生存期为26个月，5年精算生存率为19%。再次放疗后接受手术切除的患者的中位生存期和5年生存率分别为44个月和22%，而仅接受再次放疗患者的分别为14个月和15%（P = 0.001）。治疗一般耐受性良好。15例患者因3级及以上腹泻、湿性脱皮或黏膜炎需要中断治疗并提前终止治疗。22例患者出现晚期并发症，包括18例持续性严重腹泻，其中10例患者需要长期肠外营养支持，15例患者出现小肠梗阻，4例患者出现瘘管形成，2例患者出现结肠肛管狭窄。所给予的总放疗剂量在急性或长期并发症发生率方面无差异。
对于复发性直肠癌患者，高剂量再次放疗的风险可接受，且无严重的长期副作用。患者进行手术挽救和长期生存是可能的。
