Habr-Gama Angelita, Perez Rodrigo Oliva, Kiss Desidério Roberto, Rawet Viviane, Scanavini Arceu, Santinho Pedro Marcos, Nadalin Wladimir
Division of Coloproctology, Department of Gastroenterology, University of São Paulo, Brazil.
Hepatogastroenterology. 2004 Nov-Dec;51(60):1703-7.
BACKGROUND/AIMS: Multimodality treatment is the preferred strategy in the management of low rectal adenocarcinoma. Preoperative chemoradiation therapy (CRT) associated with radical surgery may result in significant tumor downstaging, local control of the disease and high rates of sphincter-saving operations.
One hundred consecutive patients with advanced and resectable distal rectal cancer treated either by surgery alone or by preoperative chemoradiation followed by surgery were reviewed. Both groups were similar in tumor and patients characteristics. Treatment strategy was randomly selected.
Mean tumor size in Group 1 (surgery alone) was 6.1 cm and 3.3 cm in Group 2 (CRT). In Group 1 (surgery alone), nine patients had stage I (18%), 20 had stage II (40%) and 21 had stage III disease (42%). In Group 2 (CRT), 6 patients had stage 0 (12%), 21 had stage I (42%), 12 had stage II (24%) and 11 had stage III disease (22%). Furthermore, for each T (except for T0-1) the presence of lymph node (LN) metastasis was significantly more frequent in Group 1. In Group 2 (CRT), there was a mean reduction of 27% of the initial tumor size. This reduction was observed in 58% of patients in this group (CRT). Finally, sphincter-saving operations were more frequently performed in Group 2 (CRT) even though tumor differentiation and distance from the anal verge were similar in both groups.
Preoperative CRT followed by radical surgery is an effective treatment strategy for distal rectal cancer resulting in significant tumor size reduction and downstaging. Consequently, these effects may be responsible for higher rates of sphincter-saving operations performed in this subset of patients.
背景/目的：多模式治疗是低位直肠腺癌治疗的首选策略。术前放化疗（CRT）联合根治性手术可显著降低肿瘤分期，实现疾病的局部控制，并提高保肛手术的成功率。
回顾性分析100例连续的晚期可切除性远端直肠癌患者，这些患者分别接受单纯手术或术前放化疗后手术治疗。两组患者的肿瘤和患者特征相似。治疗策略随机选择。
第1组（单纯手术组）的平均肿瘤大小为6.1cm，第2组（CRT组）为3.3cm。在第1组（单纯手术组）中，9例患者为I期（18%），20例为II期（40%），21例为III期疾病（42%）。在第2组（CRT组）中，6例患者为0期（12%），21例为I期（42%），12例为II期（24%），11例为III期疾病（22%）。此外，对于每个T分期（T0-1除外），第1组淋巴结转移的发生率显著更高。在第2组（CRT组）中，初始肿瘤大小平均减少了27%。该组58%的患者出现了这种缩小。最后，尽管两组患者的肿瘤分化程度和距肛缘距离相似，但第2组（CRT组）更频繁地进行了保肛手术。
术前CRT后行根治性手术是治疗远端直肠癌的有效策略，可显著减小肿瘤大小并降低分期。因此，这些效果可能是该亚组患者保肛手术成功率较高的原因。
