Department of Surgery, Chungnam National University Hospital, Daejeon, Korea.
Int J Colorectal Dis. 2010 Sep;25(9):1103-10. doi: 10.1007/s00384-010-0970-1. Epub 2010 Jun 11.
The benefit of adjuvant radiotherapy in patients with stage IIA (T3N0) rectal cancer following total mesorectal excision (TME) is controversial. We evaluated the effect of adjuvant chemoradiotherapy (CRT) versus chemotherapy (CT) alone on the local recurrence and survival of patients with stage IIA rectal cancer after TME.
Between 1996 and 2004, patients with stage IIA rectal cancer who received adjuvant CT (n = 29) or CRT (n = 122) following TME were enrolled. Oncologic outcomes were compared between groups, and risk factors for local recurrence and overall survival rates were analyzed.
The median follow-up period was 78 months. No significant differences were observed in the 5-year local recurrence (3.4% versus 9.0%; P = 0.348) or 5-year overall survival rates (86.2% versus 80.3%; P = 0.924) between CT and CRT. However, involvement of the circumferential resection margin and age >60 years were associated with adverse oncologic outcomes.
Additional postoperative radiotherapy did not alter local recurrence or survival after TME in patients with stage IIA rectal cancer. Postoperative radiation may be an overtreatment as an adjuvant therapy in patients with stage IIA rectal cancer if they had no other risk factors. However, randomized controlled trials are warranted to confirm this suggestion.
在接受全直肠系膜切除术（TME）后，ⅡA 期（T3N0）直肠癌患者辅助放疗的获益存在争议。我们评估了辅助放化疗（CRT）与单纯化疗（CT）对 TME 后ⅡA 期直肠癌患者局部复发和生存的影响。
1996 年至 2004 年间，接受 TME 后辅助 CT（n=29）或 CRT（n=122）治疗的ⅡA 期直肠癌患者入组。比较两组的肿瘤学结局，并分析局部复发和总生存率的危险因素。
中位随访时间为 78 个月。两组 5 年局部复发率（3.4%与 9.0%；P=0.348）和 5 年总生存率（86.2%与 80.3%；P=0.924）无显著差异。然而，环周切缘受侵和年龄＞60 岁与不良肿瘤学结局相关。
在ⅡA 期直肠癌患者中，TME 后辅助放疗并未改变局部复发或生存。如果ⅡA 期直肠癌患者没有其他危险因素，术后放疗可能是一种过度治疗的辅助治疗方法。然而，需要进行随机对照试验来证实这一建议。
