Påhlman L, Glimelius B
Department of Surgery, University Hospital, Uppsala, Sweden.
Scand J Gastroenterol Suppl. 1988;149:82-9.
Surgery alone is not sufficient for a large group of patients with adenocarcinoma of the rectum. With a combination of surgery and radiotherapy a significantly decreased local recurrence rate has been found, provided that the dose level has been sufficiently high. Whether a combined treatment has an impact on survival is too early to determine. An essential question is whether this additional treatment with irradiation should be given to all patients with rectal carcinoma, i.e. preoperatively or only to patients in Dukes' stage B or C, i.e. postoperatively. For several reasons mentioned in this paper preoperative radiotherapy is to be preferred. Furthermore, a postoperative regime is more difficult to handle within the desired schedule times. Also, data obtained in the Uppsala trial further indicate that a brief, convenient and apparently safe preoperative regime may result in a lower rate of local recurrence than an optimized postoperative regime. It is too early, however, to state that all patients with rectal carcinoma should have combined treatment. Further controlled trials, preferably with preoperative high-dose irradiation schedules, have to be carried out before the benefit of radiotherapy can be said to be conclusively proved. It is also important, however, that the surgical procedure be optimal, since irradiation cannot, and should not, serve as a substitute for poor surgery.
对于一大批直肠癌患者而言，单纯手术治疗并不足够。若将手术与放疗相结合，在放疗剂量足够高的情况下，局部复发率会显著降低。联合治疗是否对生存率有影响，目前判断还为时过早。一个关键问题是，这种额外的放疗是应给予所有直肠癌患者（即术前放疗），还是仅给予处于Dukes B期或C期的患者（即术后放疗）。基于本文提到的几个原因，术前放疗更可取。此外，术后治疗方案在规定的时间安排内更难操作。而且，乌普萨拉试验获得的数据进一步表明，一个简短、便捷且明显安全的术前治疗方案可能比优化后的术后治疗方案导致更低的局部复发率。然而，现在就说所有直肠癌患者都应接受联合治疗还为时过早。在放疗的益处被确凿证明之前，还必须进行进一步的对照试验，最好是采用术前高剂量放疗方案。不过，手术操作达到最佳状态也很重要，因为放疗不能也不应该替代糟糕的手术。
