Penopoulos V, Handolias M, Avgerinos A, Maris T, Ilias T, Issopoulos N, Christianopoulos G, Betsis D, Vrettou E, Kitis G, Pistevou K
2nd Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou Regional General Hospital, Greece.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1280-7.
BACKGROUND/AIMS: Randomized Swedish studies demonstrate the efficacy of a 5-fraction course of preoperative radiotherapy for rectal carcinoma. The present study evaluates the results in a single Greek institution over a 10-year period, with a similar regimen.
During the period of 1995-2000, 150 consecutive patients with Dukes' B or C rectal cancer were matched to receive preoperative radiotherapy (Group I) or not (Group II). Seventy-five patients received pelvic radiotherapy of 2500cGY/5 fractions, followed by surgery within one week. Radiotherapy was delivered through 4 portals, with the patient lying in the prone position. A CT scan was used to define treatment volume. The 5-fraction course was used for lesions that seemed readily resectable. Patients in both groups received adjuvant chemotherapy. Local recurrence, disease-free interval and 5-year survival were evaluated and analyzed.
The disease-free interval was significantly longer in Group I (p < 0.0005). This benefit was mainly due to a significantly lower incidence of local recurrence in Group I (9/75, 12%) compared with Group II (30/75, 40%) (p < 0.0005). The incidence of distant metastases was not significantly different between the 2 groups. The 5-year survival for all patients, who underwent "curative" surgery was significantly higher in Group I (77.3%) as compared to Group II (39%), (p < 0.0005).
Patients with resectable rectal cancer who received 2500cGy/5 fractions preoperative radiotherapy to the pelvis had excellent local control of disease, longer disease-free interval and higher 5-year survival than patients who did not. These patients were able to undergo sphincter preserving surgery and adjuvant chemotherapy.
背景/目的：瑞典的随机研究证明了直肠癌术前5次分割放疗疗程的疗效。本研究评估了希腊一家机构在10年期间采用类似方案的结果。
在1995年至2000年期间，150例连续的 Dukes' B 或 C 期直肠癌患者被配对，分别接受术前放疗（第一组）或不接受术前放疗（第二组）。75例患者接受了2500cGy/5次分割的盆腔放疗，随后在一周内进行手术。放疗通过4个射野进行，患者俯卧位。使用CT扫描来确定治疗体积。5次分割疗程用于看起来易于切除的病变。两组患者均接受辅助化疗。对局部复发、无病间期和5年生存率进行评估和分析。
第一组的无病间期明显更长（p < 0.0005）。这种益处主要是由于第一组的局部复发发生率（9/75，12%）明显低于第二组（30/75，40%）（p < 0.0005）。两组之间远处转移的发生率没有显著差异。接受“根治性”手术的所有患者的5年生存率在第一组（77.3%）明显高于第二组（39%）（p < 0.0005）。
与未接受放疗的患者相比，接受盆腔2500cGy/5次分割术前放疗的可切除直肠癌患者对疾病有良好的局部控制，无病间期更长，5年生存率更高。这些患者能够接受保肛手术和辅助化疗。
