Wiig Johan N, Giercksky Karl-Erik, Tveit Kjell M
Department of Gastroenterological Surgery, The Norwegian Radium Hospital, Oslo University Hospital , Oslo , Norway.
Acta Oncol. 2014 Jul;53(7):865-76. doi: 10.3109/0284186X.2014.895037. Epub 2014 Mar 28.
Intraoperative radiotherapy (IORT) has been given for primary and locally recurrent rectal cancer for 30 years. Still, its effect is not clear.
PubMed and EMBASE search for papers after 1989 on surgical treatment and external beam radiotherapy (EBRT) for primary advanced and locally recurrent rectal cancer, with and without IORT. From each center the most recent paper was generally selected. Survival and local recurrence at five years was tabulated for the total groups and separate R-stages. Also, the technique for IORT, use of EBRT and chemotherapy as well as surgical approach was registered.
In primary cancer 18 papers from 14 centers were tabulated, including one randomized and five internally comparing studies, as well as seven studies without IORT. In locally recurrent cancer 18 papers from 13 centers were tabulated, including four internally comparing studies and also five without IORT. Overall survival (OS) and local recurrence rate (LRR) were higher for primary cancer compared to recurrent cancer. Patients with R0 resections had better outcome than patients with R1 or R2 resections. For primary cancer OS and LR rate of the total groups and R0 stages was not influenced by IORT. An effect on R1/R2 stages cannot be excluded. The only randomized study (primary cancer) did not show any effect of IORT.
IORT does not convincingly improve OS and LR rate for primary and locally recurrent rectal cancer. If there is an effect of IORT, it is small and cannot be shown outside randomized studies analyzing the separate R stages.
术中放疗（IORT）已应用于原发性和局部复发性直肠癌30年。但其效果仍不明确。
检索PubMed和EMBASE数据库，查找1989年以后关于原发性进展期和局部复发性直肠癌手术治疗及外照射放疗（EBRT）的文献，包括有无IORT的情况。通常从每个中心选取最新的文献。将全部病例组及不同R分期的5年生存率和局部复发率制成表格。同时，记录IORT技术、EBRT和化疗的使用情况以及手术方式。
原发性癌方面，汇总了来自14个中心的18篇文献，包括1篇随机对照研究、5篇自身对照研究以及7篇未采用IORT的研究。局部复发性癌方面，汇总了来自13个中心的18篇文献，包括4篇自身对照研究以及5篇未采用IORT的研究。原发性癌的总生存率（OS）和局部复发率（LRR）高于复发性癌。R0切除的患者比R1或R2切除的患者预后更好。对于原发性癌，全部病例组及R0分期的OS和LR率不受IORT影响。不能排除IORT对R1/R2分期有影响。唯一的随机对照研究（原发性癌）未显示IORT有任何效果。
IORT不能令人信服地提高原发性和局部复发性直肠癌的OS和LR率。如果IORT有效果，其效果也很小，且在分析不同R分期的随机对照研究之外无法体现。
