Simunovic M, Sexton R, Rempel E, Moran B J, Heald R J
Department of Surgical Oncology, Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada.
Br J Surg. 2003 Aug;90(8):999-1003. doi: 10.1002/bjs.4210.
Radiation is being used increasingly in the management of patients with rectal cancer. Over the past decade the Basingstoke Colorectal Research Unit has combined precision total mesorectal excision with the highly selective use of preoperative radiotherapy.
One hundred and fifty consecutive patients who underwent major surgical excision for cancers of all stages comprised the study group. Preoperative clinical assessment was based largely on tumour size, fixation and distance from the anal verge. Only preoperative radiotherapy was considered and this only for tumours judged to be at high risk of mesorectal fascia involvement.
During a 5-year period 35 of 150 patients were selected for preoperative irradiation. In the non-irradiated patients the local recurrence rate after a median follow-up period of 870 (range 51-1903) days was 2.6 per cent (three of 115 patients), compared with 17.1 per cent (six of 35 patients) in those chosen for irradiation. Sixty patients (52.2 per cent) who were not irradiated were node positive. The local recurrence rate for the whole group was 6.0 per cent.
The great majority of patients undergoing major excision for rectal cancer can be managed without radiation therapy if the preoperative assessment of the mesorectal fascia and surgery are performed optimally.
放射治疗在直肠癌患者的治疗中应用越来越广泛。在过去十年中，贝辛斯托克结直肠癌研究单位将精准全直肠系膜切除术与高度选择性的术前放疗相结合。
连续150例接受各期癌症大手术切除的患者组成研究组。术前临床评估主要基于肿瘤大小、固定情况以及距肛缘的距离。仅考虑术前放疗，且仅用于判断有直肠系膜筋膜受累高风险的肿瘤。
在5年期间，150例患者中有35例被选作术前放疗。在未接受放疗的患者中，中位随访870天（范围51 - 1903天）后的局部复发率为2.6%（115例患者中有3例），而在接受放疗的患者中这一比例为17.1%（35例患者中有6例）。60例（52.2%）未接受放疗的患者有淋巴结转移。全组的局部复发率为6.0%。
如果对直肠系膜筋膜进行最佳的术前评估并实施最佳手术，绝大多数接受直肠癌大手术切除的患者无需放疗即可得到治疗。
