Pacelli Fabio, Di Giorgio Andrea, Papa Valerio, Tortorelli Antonio Pio, Covino Marcello, Ratto Carlo, Bossola Maurizio, Valentini Vincenzo, Sofo Luigi, Miccichè Francesco, Gambacorta Maria Antonietta, Doglietto Giovanni Battista
Department of Surgical Sciences--Digestive Surgery Unit, Catholic University, School of Medicine, Rome, Italy.
Dis Colon Rectum. 2004 Feb;47(2):170-9. doi: 10.1007/s10350-003-0028-3.
The survival advantage of preoperative radiotherapy in patients with rectal cancer is still a matter of debate, because its incremental benefit in the total mesorectal excision setting is unclear. This study was designed to evaluate early and long-term results of preoperative radiotherapy plus intraoperative radiotherapy in a homogeneous population of T3 middle and lower rectal cancer patients submitted to total mesorectal excision.
A series of 113 patients with middle and lower T3 rectal cancer consecutively submitted to total mesorectal excision at a single surgical unit from 1991 to 1997 were divided into two groups according to type of neoadjuvant treatment: preoperative radiotherapy (38 Gy) plus intraoperative radiotherapy (10 Gy; n = 69), and no preoperative treatment (total mesorectal excision; n = 44). Standard statistical analyses were used to evaluate early (downstaging, intraoperative factors, hospital morbidity, and mortality rates) and long-term results (recurrence and survival).
Overall, 68.2 percent of patients were downstaged by the preoperative regimens (T0 specimens in 3 cases). Postoperative complications were comparable in the two groups. Five-year, disease-specific survival was 81.4 and 58.1 percent in preoperative radiotherapy plus intraoperative radiotherapy group and total mesorectal excision group, respectively (P = 0.052). Corresponding figures for disease-free survival were 73.1 and 57.2 percent in the two groups, respectively (P = 0.096). The rates of local recurrence at five years were 6.6 and 23.2 percent in preoperative radiotherapy plus intraoperative radiotherapy and total mesorectal excision groups, respectively (P = 0.017).
Preoperative radiotherapy plus intraoperative radiotherapy associated with total mesorectal excision reduce local recurrence rate and improve survival in T3 rectal cancer compared with total mesorectal excision alone.
术前放疗对直肠癌患者的生存优势仍存在争议，因为其在全直肠系膜切除术中的额外获益尚不清楚。本研究旨在评估术前放疗联合术中放疗在接受全直肠系膜切除术的T3期低位和中位直肠癌患者同质群体中的早期和长期结果。
1991年至1997年在单个手术单元连续接受全直肠系膜切除术的113例低位和中位T3期直肠癌患者，根据新辅助治疗类型分为两组：术前放疗（38 Gy）联合术中放疗（10 Gy；n = 69），以及未进行术前治疗（全直肠系膜切除术；n = 44）。采用标准统计分析评估早期结果（降期、术中因素、医院发病率和死亡率）和长期结果（复发和生存）。
总体而言，68.2%的患者通过术前方案实现降期（3例为T0标本）。两组术后并发症相当。术前放疗联合术中放疗组和全直肠系膜切除组的5年疾病特异性生存率分别为81.4%和58.1%（P = 0.052）。两组无病生存率的相应数字分别为73.1%和57.2%（P = 0.096）。术前放疗联合术中放疗组和全直肠系膜切除组的5年局部复发率分别为6.6%和23.2%（P = 0.017）。
与单纯全直肠系膜切除术相比，术前放疗联合术中放疗并全直肠系膜切除术可降低T3期直肠癌的局部复发率并提高生存率。
