Meadows Kenyon, Morris Christopher G, Rout W Robert, Zlotecki Robert A, Hochwald Steven N, Marsh Robert D, Copeland Edward M, Mendenhall William M
Department of Radiation Oncology, University of Florida, Gainesville, FL 32510-0385, USA.
Am J Clin Oncol. 2006 Oct;29(5):430-4. doi: 10.1097/01.coc.0000217830.87635.83.
To evaluate the efficacy of preoperative radiotherapy (RT) and chemoradiation (CRT) followed by transanal excision (TAE) for rectal adenocarcinoma.
Thirty-two patients were treated between July 1988 and April 2004 and followed from 2 to 123 months (median, 27 months).
The 3-year outcomes were: locoregional control, 79%; distant metastasis-free survival, 80%; cause-specific survival, 88%; and overall survival, 75%. Outcomes were better for patients with T1-T2 tumors and those who experienced a complete response to preoperative RT or CRT. Two patients (6%) had chronic RT proctitis after treatment.
A select subset of patients with T2/T3 tumors will experience similar outcomes after preoperative RT or CRT and TAE compared with radical proctectomy. Reliably predictive clinicopathologic features to define this subgroup would best be elicited in the context of large prospective randomized trials, as would the optimal combination and schedule of systemic agents delivered in conjunction with preoperative RT. Patients who experience a complete response (cCR) after preoperative CRT are excellent candidates for TAE; those with less than a cCR have a less-favorable prognosis and are probably better treated with a low anterior resection or abdominal-perineal resection.
评估术前放疗（RT）及放化疗（CRT）联合经肛门切除术（TAE）治疗直肠腺癌的疗效。
1988年7月至2004年4月期间对32例患者进行了治疗，并随访2至123个月（中位时间为27个月）。
3年的结果如下：局部区域控制率为79%；无远处转移生存率为80%；病因特异性生存率为88%；总生存率为75%。T1-T2期肿瘤患者以及对术前RT或CRT有完全反应的患者预后较好。2例患者（6%）治疗后出现慢性放射性直肠炎。
与根治性直肠切除术相比，部分T2/T3期肿瘤患者术前RT或CRT联合TAE可获得相似的预后。在大型前瞻性随机试验中最能明确界定该亚组患者的可靠预测性临床病理特征，以及与术前RT联合使用的全身药物的最佳组合和方案。术前CRT后达到完全缓解（cCR）的患者是TAE的理想候选者；未达到cCR的患者预后较差，可能采用低位前切除术或腹会阴联合切除术治疗效果更佳。
