Höcht Stefan, Hammad Riad, Thiel Hans-Joachim, Wiegel Thomas, Siegmann Alessandra, Willner Jochen, Wust Peter, Herrmann Thomas, Eble Michael, Flentje Michael, Carstens Detlef, Bottke Dirk, Neumann Patrick, Hinkelbein Wolfgang
Department of Radiation Oncology and Radiotherapy, Charité Campus Benjamin Franklin, Berlin, Germany.
Strahlenther Onkol. 2004 Jan;180(1):15-20. doi: 10.1007/s00066-004-1130-8.
Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently.
123 patients were evaluated with the help of a CT-based self-developed 3-D data file system and an extensive questionnaire. Major inclusion criteria (one sufficient) for eligibility were: histological confirmation, clear bone destruction, and a positive PET scan, or at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serologic signs of inflammation were exclusion criteria.
Initially, 54% of the evaluated patients were N0; in the remainder, N1 and N2 were distributed evenly. Initial T-category was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%, the male-to-female ratio was 2:1. Recurrent tumors were mainly situated in the posterior part of the bony pelvis as displayed in the figures. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis (p<0.025 in all statistical tests applied), whereas no significant difference was found in the superior parts of the pelvis.
Based on these results, a modest field size reduction in adjuvant radiotherapy for rectal cancer seems feasible, offering the perspective of a reduction in acute and late side effects.
直肠癌辅助放疗中放射野的推荐主要基于复发模式分析。为评估手术技术的改变是否影响了这种复发模式，对近期治疗的患者群体进行了多中心回顾性分析。
借助基于CT自行开发的三维数据文件系统和一份详尽的问卷对123例患者进行评估。纳入资格的主要标准（满足其一即可）为：组织学确诊、明确的骨质破坏、PET扫描阳性，或至少满足三项次要标准：软组织肿块进展、随访CT或MRI显示侵犯相邻器官、肿瘤标志物升高以及横断面成像中的典型表现。炎症的临床或血清学迹象为排除标准。
最初，54%的评估患者为N0；其余患者中，N1和N2分布均匀。初始T分期为T1的占2%，T2的占24%，T3的占60%，T4的占13%，男女比例为2:1。如图所示，复发性肿瘤主要位于骨盆后部。当将腹会阴联合切除术与低位前切除术作为初次手术进行比较时，骨盆下部复发性肿瘤的范围存在显著差异（在所有应用的统计检验中p<0.025），而骨盆上部未发现显著差异。
基于这些结果，直肠癌辅助放疗适度缩小照射野似乎可行，有望减少急性和晚期副作用。
