Srinivasaiah N, Joseph B, Mackey P, Monson J R T
Academic Surgical Unit, University of Hull and Castle Hill Hospital, Hull, UK.
Colorectal Dis. 2008 May;10(4):357-62. doi: 10.1111/j.1463-1318.2007.01366.x. Epub 2007 Aug 31.
The role of neoadjuvant radiotherapy in the management of rectal cancers has not reached a consensus in colorectal surgical practice. In the light of the preliminary results of the CRO7 trial, we undertook a national questionnaire survey to assess the current pattern of practice in the UK. The aim of this study was to assess the correlation between CRO7 trial results and current practice amongst consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI).
A 14-item questionnaire was designed to inquire into the current management strategy of operable rectal cancers and the possible role of neoadjuvant radiotherapy. The postal questionnaire survey was sent to all the 400 active consultant surgical members of the ACPGBI.
Of 400 questionnaires, 200 (50%) were returned fully completed. One hundred and sixty-six (83%) of surgeons did not routinely use neoadjuvant short course radiotherapy (NASCRT) in clinically operable rectal cancers (T1/T2) <15 cm from anal verge with no metastases (The CR07 eligible cohort). Sixty-four (32%) used NASCRT for T3 cancers routinely whereas 76 (38%) used neoadjuvant long course radiotherapy instead. One hundred and fifty-sixty (78%) of the surgeons felt the height of the tumour from the anal verge influenced their decision on NASCRT, while 104 (52%) felt position was important (Anterior/Posterior). Positive anticipated margins of excision on magnetic resonance imaging was a deciding factor for 185 (92.5%) of surgeons in favour of neoadjuvant therapy. Postoperatively in patients who have not had preoperative radiotherapy, 154 (77%) recommended radiotherapy and 155 (77.5%) recommended chemotherapy if the circumferential resection margin was +ve on final pathology. Seventy-eight (39%) of the surgeons have changed their practice after the preliminary results of the CRO7 by adopting NASCRT for treating early rectal cancers.
Despite the evidence of the CRO7 trial supporting the use of NASCRT for operable rectal cancer, approximately two-third of consultant surgeons in the UK have yet to implement this treatment regime routinely. A change in practice in 39% of surgeons following the early dissemination of trial results indicate that colorectal surgeons practice is guided by scientific evidence. Because the mature trial data have yet to be published, a further survey of practice is warranted after that publication to determine the ultimate impact of this trial. This survey measures the baseline practice to compare changes over the next 2 years.
在结直肠外科实践中，新辅助放疗在直肠癌治疗中的作用尚未达成共识。鉴于CRO7试验的初步结果，我们开展了一项全国性问卷调查，以评估英国目前的实践模式。本研究的目的是评估CRO7试验结果与英国和爱尔兰结直肠外科学会（ACPGBI）顾问成员当前实践之间的相关性。
设计了一份包含14个条目的问卷，以探究可手术直肠癌的当前管理策略以及新辅助放疗的可能作用。通过邮寄方式向ACPGBI的所有400名在职顾问外科成员发送了问卷调查。
在400份问卷中，200份（50%）被完整返还。166名（83%）外科医生在距离肛缘<15 cm且无转移的临床可手术直肠癌（T1/T2）（CRO7符合条件队列）中不常规使用新辅助短程放疗（NASCRT）。64名（32%）医生常规对T3期癌症使用NASCRT，而76名（38%）医生则使用新辅助长程放疗。156名（78%）外科医生认为肿瘤距肛缘的高度会影响他们对NASCRT的决策，而104名（52%）医生认为位置（前/后）很重要。磁共振成像显示的阳性预期切缘是185名（92.5%）支持新辅助治疗的外科医生的决定因素。在未接受术前放疗的患者术后，如果最终病理显示环周切缘为阳性，154名（77%）医生推荐放疗，155名（77.5%）医生推荐化疗。78名（39%）外科医生在CRO7试验的初步结果公布后改变了他们的做法，开始采用NASCRT治疗早期直肠癌。
尽管CRO7试验的证据支持对可手术直肠癌使用NASCRT，但英国约三分之二的顾问外科医生尚未常规实施这种治疗方案。39%的外科医生在试验结果早期传播后改变了做法，这表明结直肠外科医生的实践是以科学证据为指导的。由于成熟的试验数据尚未发表，在数据发表后有必要进一步开展实践调查，以确定该试验的最终影响。本次调查测量了基线实践情况，以便比较未来两年的变化。
