Ferenschild Floris T J, Vermaas Maarten, Nuyttens Joost J M E, Graveland Wilfried J, Marinelli Andreas W K S, van der Sijp Joost R, Wiggers Theo, Verhoef Cornelis, Eggermont Alexander M M, de Wilt Johannes H W
Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, 3008 AE Rotterdam, The Netherlands.
Dis Colon Rectum. 2006 Sep;49(9):1257-65. doi: 10.1007/s10350-006-0651-x.
This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer.
Between 1987 and 2002, 123 patients with initial unresectable and locally advanced rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathologic reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed.
All patients were treated preoperatively with a median dose of 50 Gy radiotherapy. Surgery was performed six to ten weeks after radiotherapy. Twenty-seven patients were treated with intraoperative radiotherapy because margins were incomplete or </=2 mm. Postoperative mortality was 2 percent. The median follow-up of all patients was 25.1 months. The overall five-year local control was 65 percent and the overall five-year survival was 50 percent. Positive lymph nodes and incomplete resections negatively influenced local control and overall survival. Intraoperative radiotherapy improved five-year local control (58 vs. 0 percent, P = 0.016) and overall survival (38 vs. 0 percent, P = 0.026) for patients with R1/2 resections.
The presented multimodality treatment is feasible with an acceptable mortality and a five-year overall survival of 50 percent. Addition of intraoperative radiotherapy for patients with a narrow or microscopic incomplete resection seems to overrule the unfavorable prognostic histologic finding.
本研究旨在分析原发性局部晚期直肠癌患者采用术前放疗，随后进行手术及术中放疗的多模式治疗结果。
1987年至2002年间，在我们的前瞻性数据库中识别出123例初始不可切除的局部晚期直肠癌患者，该数据库包含患者特征、放疗计划、手术记录、组织病理学报告及随访细节。对局部复发、远处转移及总生存的预后因素进行了评估。
所有患者术前均接受了中位剂量为50 Gy的放疗。放疗后6至10周进行手术。27例患者因切缘不完整或≤2 mm接受了术中放疗。术后死亡率为2%。所有患者的中位随访时间为25.1个月。总体五年局部控制率为65%，总体五年生存率为50%。阳性淋巴结及切除不完整对局部控制和总生存有负面影响。术中放疗改善了R1/2切除患者的五年局部控制率（58%对0%，P = 0.016）和总生存率（38%对0%，P = 0.026）。
所呈现的多模式治疗是可行的，死亡率可接受，五年总生存率为50%。对于切缘狭窄或显微镜下切除不完整的患者，术中放疗的加入似乎可克服不利的预后组织学发现。
