Goethals L, Haustermans K, Perneel C, Bussels B, D'Hoore A, Geboes K, Ectors N, Van Cutsem E, Van den Bogaert W, Penninckx F
Department of Radiation Oncology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Eur J Surg Oncol. 2005 Nov;31(9):969-76. doi: 10.1016/j.ejso.2005.03.011. Epub 2005 Jun 3.
To determine the differences in downstaging, local control (LC), disease free survival (DFS) and overall survival (OS) between combined pre-operative chemoradiation and pre-operative radiotherapy alone in the treatment of resectable rectal cancer.
One hundred and ten patients who underwent pre-operative radiotherapy or chemo-radiotherapy were reviewed. Fifty-seven patients were treated with radiotherapy (30 Gy/3 Gy) alone and 53 patients with chemo-radiotherapy (bolus 5FU+45 Gy/1.8 Gy). The median interval between the end of neo-adjuvant treatment and surgery was 28 and 46 days for the patients treated with radiotherapy alone and chemo-radiotherapy.
The groups were homogeneously distributed for all characteristics except for cN-stage with more clinically node positive patients in the combined modality treatment group (47 vs 73%). A significant downstaging for tumour and/or lymph node status was observed in both groups. More ypT0-x-is were observed after chemoradiation than after radiotherapy alone (26 vs 7%; p=0.02). The local control rate at 3 years was 94% for both groups. DFS after radiation and chemoradiation was comparable with a 3-year DFS of 83 and 88%, respectively.
Both pre-operative schemes have similar outcomes concerning DFS, OS and LC. Tumour downstaging is associated with improved survival.
确定术前联合放化疗与单纯术前放疗在可切除直肠癌治疗中降期、局部控制（LC）、无病生存（DFS）和总生存（OS）方面的差异。
回顾了110例行术前放疗或放化疗的患者。57例患者仅接受放疗（30 Gy/3 Gy），53例患者接受放化疗（推注5-氟尿嘧啶+45 Gy/1.8 Gy）。单纯放疗和放化疗患者新辅助治疗结束至手术的中位间隔时间分别为28天和46天。
除cN分期外，两组在所有特征上分布均匀，联合治疗组临床淋巴结阳性患者更多（47%对73%）。两组均观察到肿瘤和/或淋巴结状态有显著降期。放化疗后观察到的ypT0-x-is比单纯放疗后更多（26%对7%；p=0.02）。两组3年局部控制率均为94%。放疗和放化疗后的DFS相当，3年DFS分别为83%和88%。
两种术前方案在DFS、OS和LC方面有相似的结果。肿瘤降期与生存改善相关。
