Minsky B D, Cohen A M, Enker W E, Sigurdson E
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Int J Radiat Oncol Biol Phys. 1992;23(2):387-92. doi: 10.1016/0360-3016(92)90757-9.
A total of 22 patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of pre-operative radiation therapy+low anterior resection/coloanal anastomosis. By pre-operative assessment, all patients had invasive tumors involving the distal half of the rectum and required an abdominoperineal resection. The median tumor size was 4 cm (1.5-6 cm) and the median distance from the anal verge was 4 cm (3-7 cm). The whole pelvis received 4680 cGy followed by a 360 cGy boost to the primary tumor bed. The median follow-up was 29 months (10-60 months). Of the 21 patients who underwent resection, 10% had a complete pathologic response and 90% were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure as a component of failure was crude: 23% and 4-year actuarial: 32%. The 4-year actuarial survival was 61%. No patients experienced Grade 3 or 4 toxicity while receiving radiation therapy, and 6% developed a partial disruption of the anastomosis. Of the patients who underwent a low anterior resection/coloanal anastomosis, 89% had a good or excellent functional result. This technique may be an alternative to an abdominoperineal resection in selected patients. Further follow-up is needed in order to determine if this approach ultimately has similar local control and survival rates as an abdominoperineal resection.
共有22例诊断为侵袭性、可切除、局限于盆腔的原发性直肠腺癌患者参加了一项术前放射治疗+低位前切除术/结肠肛管吻合术的I/II期试验。通过术前评估，所有患者均有侵犯直肠远端一半的侵袭性肿瘤，需要行腹会阴联合切除术。肿瘤大小中位数为4 cm（1.5 - 6 cm），距肛缘距离中位数为4 cm（3 - 7 cm）。全盆腔接受4680 cGy照射，随后对原发肿瘤床追加360 cGy照射。中位随访时间为29个月（10 - 60个月）。在接受手术切除的21例患者中，10%有完全病理缓解率，90%能够成功进行低位前切除术/结肠肛管吻合术。作为失败组成部分的局部失败发生率粗略为23%，4年精算发生率为32%。4年精算生存率为61%。在接受放射治疗期间，没有患者出现3级或4级毒性反应，6%发生了吻合口部分破裂。在接受低位前切除术/结肠肛管吻合术的患者中，89%功能结果良好或优秀。对于部分患者，这种技术可能是腹会阴联合切除术的一种替代方法。需要进一步随访以确定这种方法最终是否具有与腹会阴联合切除术相似的局部控制率和生存率。
