Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
Semin Radiat Oncol. 2011 Jul;21(3):220-7. doi: 10.1016/j.semradonc.2011.02.008.
There are 2 types of neoadjuvant radiation regimens accepted as standard for resectable rectal cancer: short-course (5 × 5 Gy) radiation therapy alone with immediate surgery and long-course combined chemoradiation therapy with delayed surgery. A Polish randomized study (n = 312) and an Australian randomized study (n = 326) compared these 2 schedules. Both trials showed a lower rate of early adverse effects using a short-course radiation regimen and no differences in long-term oncologic outcomes and late toxicity rates between groups. The small number of fractions makes short-course radiation less expensive and more convenient than chemoradiation therapy. These facts indicate that short-course radiation is preferable to chemoradiation for resectable cancers. Additionally, short-course preoperative radiation with a long interval to surgery is a valuable option for patients unfit for chemotherapy, with unresectable cancer or with a small tumor that is amenable to local excision. Moreover, short-course radiation enables the intensification of both radiotherapy and chemotherapy in patients with metastatic rectal cancer with potentially resectable synchronous metastatic disease.
有 2 种被接受为标准的局部可切除直肠癌新辅助放疗方案：单纯短程（5×5 Gy）放疗立即手术，以及长程联合放化疗延迟手术。一项波兰随机研究（n=312）和一项澳大利亚随机研究（n=326）比较了这 2 种方案。这两项试验均显示短程放疗方案的早期不良反应发生率较低，且组间长期肿瘤学结局和迟发性毒性发生率无差异。短程放疗的分割次数较少，因此比放化疗更经济、更方便。这些事实表明，短程放疗对于可切除的癌症是优选的。此外，对于不适合化疗、癌症不可切除或肿瘤较小适合局部切除的患者，长间隔时间手术的短程术前放疗是一种有价值的选择。此外，短程放疗使潜在可切除的同步转移性疾病的转移性直肠癌患者的放疗和化疗强度得以增强。
