De Neve W, Martijn H, Lybeert M M, Crommelin M, Goor C, Ribot J G
Department of Radiotherapy, Academic Hospital, Free University Brussels, Belgium.
Int J Radiat Oncol Biol Phys. 1991 Oct;21(5):1297-302. doi: 10.1016/0360-3016(91)90289-g.
Postoperative radiotherapy was given in 40 patients with gross or microscopic pathologically proven residual disease after surgical resection of rectum, recto-sigmoid, or sigmoid carcinoma. The radiotherapy target volume included the pelvis with (9 patients) or without (31 patients) the perineum. Median total dose of radiation was 50 Gy (range 30-60). One patient received 30 Gy, 10 received greater than 30 to 40 Gy, 13 received greater than 40 to 50 Gy, and 16 patients received greater than 50 to 60 Gy. The median follow-up in the survivors (16 patients) was 53 months (range: 16-85). Probability of survival with censoring for death due to intercurrent disease was 36% at 5 years. Survival for patients with microscopic residual disease (21 patients) was 40% at 5 years compared to 12% for those with gross residual disease (19 patients) (p = 0.09). Twenty-five patients relapsed. All but one relapse occurred earlier than 50 months after radiotherapy. Approximately half (12/25) of the relapses were observed within 6 months after radiotherapy. Local relapse inside the radiotherapy portals was observed in 9/40 (22%) patients. Therapy-related urogenital complications occurred in no patient and gastro-intestinal complications in three patients (7%). In one patient they were scored WHO grade 4 and in two patients WHO grade 3. Prognostic factors were analyzed using the Cox proportional hazards model. For survival differentiation, grade (p less than 0.001), stage (p = 0.04), and perineal irradiation (p = 0.03) were independent prognostic factors. With relapse-free survival as the endpoint, only stage (p = 0.003) was a statistically significant prognostic factor. There was a trend toward a better relapse-free survival when the perineum was included in the radiation portals (p = 0.09).
40例经病理证实为直肠、直肠乙状结肠或乙状结肠癌手术切除后存在大体或镜下残留病灶的患者接受了术后放疗。放疗靶区包括盆腔（9例患者），或不包括会阴区（31例患者）。放疗总剂量中位数为50Gy（范围30 - 60Gy）。1例患者接受30Gy，10例患者接受剂量大于30至40Gy，13例患者接受剂量大于40至50Gy，16例患者接受剂量大于50至60Gy。存活患者（16例）的中位随访时间为53个月（范围：16 - 85个月）。因并发疾病导致死亡进行截尾处理后的5年生存率为36%。镜下残留病灶患者（21例）的5年生存率为40%，而大体残留病灶患者（19例）的5年生存率为12%（p = 0.09）。25例患者复发。除1例复发外，所有复发均发生在放疗后50个月内。约一半（12/25）的复发发生在放疗后6个月内。40例患者中有9例（22%）在放疗野内出现局部复发。无患者发生与治疗相关的泌尿生殖系统并发症，3例患者（7%）发生胃肠道并发症。1例患者的并发症评分为WHO 4级，2例患者为WHO 3级。使用Cox比例风险模型分析预后因素。对于生存差异，分级（p < 0.001）、分期（p = 0.04）和会阴区照射（p = 0.03）是独立的预后因素。以无复发生存为终点，只有分期（p = 0.003）是具有统计学意义的预后因素。当放疗野包括会阴区时，无复发生存有改善的趋势（p = 0.09）。
