Tepper J E, Wood W C, Cohen A M
Radiation Medicine Service, MGH Cancer Center, Harvard Medical School, Boston, MA 02114.
Int J Radiat Oncol Biol Phys. 1989 Jun;16(6):1437-44. doi: 10.1016/0360-3016(89)90946-2.
To try to improve the local control and survival of patients with locally advanced rectal cancer we have used a combination of high-dose pre-operative radiation therapy to 5,040 cGy followed by surgical resection and intraoperative electron beam radiation therapy (IORT) when there was visible or palpable residual disease, microscopically positive surgical margins, or persisting tumor adherence. A total of 75 patients were taken to surgery for resection +/- IORT who did not have distant metastases. Of the 49 patients with primary tumors, 11 did not have IORT as the tumor was thought to be completely resected. Of these 11, there were two local recurrences and a 3-year survival of 71%. Thirty-six patients with primary tumors had resection (20 complete, 16 partial) plus IORT, with a 3-year survival of 58% and three local failures. Twenty-six additional patients were treated for locally advanced recurrence of whom four could not receive IORT because of pelvic size or the extent of tumor. Of the 22 who received IORT, 7/9 with complete resection, 2/8 with partial resection, and 1/5 with no resection had local control with an overall 3-year actuarial survival of 32%. The local control and survival results in the primary tumors appear favorable compared to other series in the literature and suggest benefit to the use of IORT. For patients treated for local recurrence, local control and long-term survival can be obtained, but the results are not as encouraging as for the primary tumors.
为了提高局部晚期直肠癌患者的局部控制率和生存率，我们采用了高剂量术前放射治疗至5040 cGy，随后进行手术切除，对于有肉眼可见或可触及的残留病灶、显微镜下手术切缘阳性或肿瘤持续粘连的患者，术中给予电子束放射治疗（IORT）。共有75例无远处转移的患者接受了手术切除±IORT。在49例原发性肿瘤患者中，11例未接受IORT，因为认为肿瘤已完全切除。在这11例患者中，有2例局部复发，3年生存率为71%。36例原发性肿瘤患者接受了切除（20例完全切除，16例部分切除）加IORT，3年生存率为58%，有3例局部复发。另外26例患者接受了局部晚期复发的治疗，其中4例因骨盆大小或肿瘤范围无法接受IORT。在接受IORT的22例患者中，9例完全切除的患者中有7例、8例部分切除的患者中有2例、5例未切除的患者中有1例实现了局部控制，总体3年精算生存率为32%。与文献中的其他系列相比，原发性肿瘤的局部控制和生存结果似乎较好，提示IORT的使用有益。对于接受局部复发治疗的患者，可以获得局部控制和长期生存，但结果不如原发性肿瘤那样令人鼓舞。
