Combes P F, Gary-Bobo J, Naja A, Nguyen-Saumon M, Bugat R, Mathieu A, el Safadi M
Bull Cancer. 1983;70(4):317-22.
Radiation therapy prescribed as an adjuvant to surgery is an effective treatment of many cancers but has not been universally accepted for treatment of rectal cancer. Since 1969, preoperative radiation therapy of rectal carcinoma has been proposed in a curative intent, both at Centre Paul Lamarque in Montpellier and at Centre Claudius Regaud in Toulouse, France. Megavoltage radiotherapy was used in all patients and doses ranges from 35 to 40 Gy during 2.5 to 3 weeks. Among the 344 patients treated between 1969 and 1981, the ratio of abdominoperineal excision to anterior resection was 239/105, the percentage of pelvic recurrence was 7,8 per cent, and the 5-year survival rate, including postoperative mortality (5.2%) was 78 per cent in the Centre Claudius Regaud series and 64 per cent in the Centre Paul Lamarque series. The 10-year survival rate was 50 per cent. There was no evidence of an increased morbidity following irradiation. Pathologic staging showed no residual tumour in the excised specimen in 5.2 per cent of the cases. The number of Dukes'C cases was smaller than according to the clinical pre-treatment assessment of the tumours (16%). Ultrasonography of the liver and plasmatic CEA determination avoid irradiation of metastatic patients. Further development of this curative approach should include a postoperative boost of 25 Gy for patients who are at high risk for local failure in the pelvis, and an adjuvant chemotherapy for Dukes'C patients.
作为手术辅助手段的放射治疗是多种癌症的有效治疗方法，但尚未被普遍接受用于直肠癌的治疗。自1969年以来，法国蒙彼利埃的保罗·拉马尔克中心和图卢兹的克劳迪乌斯·雷戈中心均提出以治愈为目的对直肠癌进行术前放射治疗。所有患者均采用兆伏级放疗，剂量在2.5至3周内为35至40戈瑞。在1969年至1981年期间接受治疗的344例患者中，腹会阴切除术与前切除术的比例为239/105，盆腔复发率为7.8%，克劳迪乌斯·雷戈中心系列中包括术后死亡率（5.2%）的5年生存率为78%，保罗·拉马尔克中心系列为64%。10年生存率为50%。没有证据表明放疗后发病率增加。病理分期显示，5.2%的病例切除标本中无残留肿瘤。杜克C期病例的数量低于肿瘤临床治疗前评估的数量（16%）。肝脏超声检查和血浆癌胚抗原测定可避免对转移患者进行放疗。这种治愈性方法的进一步发展应包括对盆腔局部复发高风险患者术后追加25戈瑞放疗，以及对杜克C期患者进行辅助化疗。
