Mohiuddin M, Marks G
Thomas Jefferson University Hospital, Department of Radiation Oncology and Medicine, Philadelphia, PA 19107.
Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):37-43. doi: 10.1016/0360-3016(91)90135-q.
Two hundred twenty patients with adenocarcinoma of the rectum have been treated in a program using high dose (greater than 4000 cGy) preoperative irradiation followed by radical surgical resection. The patients were staged on the basis of pretreatment clinical mobility of the cancers. Seventy-four patients had mobile cancers, 49 had partial fixation (tethered), 85 patients had total tumor fixation, and 12 patients had a frozen pelvis (unresectable). Patients were treated with high energy photons using a four field box technique with total doses ranging from 4000 to 6000 cGy. The overall incidence of local recurrence was 15% (32/220). Patients with fixed and unresectable tumors had a higher incidence of local recurrence, 20% (21/97) as compared with patients with mobile and partially fixed tumors, 10% (13/123). Local recurrence by pathological stage of disease was 6% for patients with Stages O, A, B1 versus 20% for patients with Stages B2 and C cancer. Overall 5-year survival of the total group was 67%. The 5-year survival by clinical stages of disease was 87% for mobile tumors, 74% for partially fixed tumors, 70% for fixed tumors, and 22% for the unresectable group. The 5-year survival by pathological stages of disease was 90% for those with Stage O, A, B1 and 71, 75, and 47%, respectively, for Stages B2, C1, and C2 disease.
220例直肠腺癌患者参与了一项治疗方案，该方案采用高剂量（大于4000 cGy）术前放疗，随后进行根治性手术切除。根据癌症治疗前的临床活动度对患者进行分期。74例患者的癌症具有活动度，49例有部分固定（受束缚），85例患者的肿瘤完全固定，12例患者有冰冻骨盆（无法切除）。患者采用高能光子，运用四野盒式技术进行治疗，总剂量范围为4000至6000 cGy。局部复发的总体发生率为15%（32/220）。与具有活动度和部分固定的肿瘤患者（10%，13/123）相比，肿瘤固定和无法切除的患者局部复发发生率更高，为20%（21/97）。疾病病理分期的局部复发率在O、A、B1期患者中为6%，而在B2期和C期癌症患者中为20%。整个组的5年总生存率为67%。按疾病临床分期的5年生存率，活动度肿瘤患者为87%，部分固定肿瘤患者为74%，固定肿瘤患者为70%，无法切除组为22%。按疾病病理分期的5年生存率，O、A、B1期患者为90%，B2、C1和C2期疾病患者分别为71%、75%和47%。
