Kang Min Kyu, Kim Myung Se, Kim Jae Hwang
Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea.
J Korean Soc Coloproctol. 2010 Aug;26(4):274-8. doi: 10.3393/jksc.2010.26.4.274. Epub 2010 Aug 31.
Although intraoperative radiotherapy (IORT) is known to be a method that can reduce local recurrence in locally advanced colorectal cancer, it is not widely used. The aim of this study was to report our experience with IORT for locally advanced rectal cancer.
From 1991 to 1994, nine patients with locally advanced rectal cancer received IORT. External beam radiotherapy was given postoperatively in five patients and preoperatively in three. Seven patients received chemotherapy. IORT was done with 6-MeV or 9-MeV electrons, and 12 Gy was irradiated at the tumor bed. The median follow-up period was 84 months (range, 15 to 208 months).
The median age of patients was 51 years (range, 42 to 73 years). All patients had advanced clinical T-stage (cT3/4) cancer. The overall and the disease-free survival rates were 66.7% and 66.7% at 5 years, respectively. One patient developed a local recurrence near the anastomosis site, which was out of the IORT field. Four patients died before the last follow-up; three from distant metastasis and one from secondary primary cancer. Adverse effects related to IORT did not occur.
Although the number of patients was small in this study, IORT is thought to be safe and effective in reducing local recurrence in locally advanced rectal cancer. However, the role of IORT should be refined in the era of preoperative radio-chemotherapy followed by total mesorectal excision.
虽然术中放疗（IORT）已知是一种可降低局部晚期结直肠癌局部复发率的方法，但它并未得到广泛应用。本研究的目的是报告我们对局部晚期直肠癌进行术中放疗的经验。
1991年至1994年，9例局部晚期直肠癌患者接受了术中放疗。5例患者术后接受了外照射放疗，3例患者术前接受了外照射放疗。7例患者接受了化疗。术中放疗采用6兆电子伏或9兆电子伏的电子束，在肿瘤床给予12 Gy的照射剂量。中位随访期为84个月（范围15至208个月）。
患者的中位年龄为51岁（范围42至73岁）。所有患者均为临床晚期T分期（cT3/4）癌症。5年时的总生存率和无病生存率分别为66.7%和66.7%。1例患者在吻合口附近出现局部复发，该部位不在术中放疗野内。4例患者在最后一次随访前死亡；3例死于远处转移，1例死于第二原发性癌症。未发生与术中放疗相关的不良反应。
虽然本研究中的患者数量较少，但术中放疗被认为在降低局部晚期直肠癌的局部复发方面是安全有效的。然而，在术前放化疗后行全直肠系膜切除术的时代，术中放疗的作用应进一步明确。
