Mohiuddin M, Marks G, Kramer S, Pajak T
Int J Radiat Oncol Biol Phys. 1984 Jul;10(7):977-80. doi: 10.1016/0360-3016(84)90166-4.
Since 1976, 104 patients with rectal cancer have been treated with a new approach of combined pre- and postoperative radiation. All patients were given 500 rad preoperative irradiation on the day of or the day before surgery. Surgery in the majority of patients was an abdominal perineal resection. The disease was then staged pathologically according to Astler-Coller's modification of Duke's staging. Patients with early stage cancer (Stages A and B1) were followed with no further therapy. Patients with poor prognostic characteristics (Stages B2, C1, C2) were given postoperative pelvic irradiation (4500 rad in 5 weeks). Twenty-nine patients were found to have Stage A or B1 cancer and were followed with no further therapy. Of these 29 patients, 1 patient developed recurrence and one has died of metastatic disease. The excellent survival of patients with early tumors indicates that minimizing the role of adjuvant therapy in this group has not been detrimental to their survival. Fifteen were found to have liver metastases at laparotomy and had just a colostomy and palliative therapy. Sixty patients had Stage B2 and C disease. Thirty-one received postoperative irradiation as per protocol. Twenty-nine patients did not receive postoperative irradiation for a variety of reasons. Follow-up ranges from 1 to 7 years in these patients. Of the 29 patients with Stage B2 and C disease who should have but did not receive postoperative radiation, 10 patients (34%) have developed a recurrence in the pelvis, and 5 other patients (17%) have developed metastatic disease. Of 31 patients who received postoperative irradiation, only 2 patients (6%) developed a local recurrence and 4 patients (13%) have developed distant metastases. Survival at 3 years was 80% for patients receiving the combined treatment, as compared to 42% for those not receiving the postoperative part of the treatment protocol.
自1976年以来，104例直肠癌患者采用了一种新的术前和术后联合放疗方法进行治疗。所有患者在手术当天或前一天接受500拉德的术前照射。大多数患者的手术方式为腹会阴联合切除术。然后根据阿斯特勒 - 科勒对杜克分期的改良对疾病进行病理分期。早期癌症（A期和B1期）患者无需进一步治疗，接受随访。具有不良预后特征（B2期、C1期、C2期）的患者术后接受盆腔照射（5周内4500拉德）。29例患者被发现患有A期或B1期癌症，无需进一步治疗，接受随访。在这29例患者中，1例出现复发，1例死于转移性疾病。早期肿瘤患者的良好生存率表明，在该组患者中尽量减少辅助治疗的作用对其生存并无不利影响。15例患者在剖腹手术时发现有肝转移，仅接受了结肠造口术和姑息治疗。60例患者患有B2期和C期疾病。31例患者按照方案接受了术后照射。29例患者由于各种原因未接受术后照射。这些患者的随访时间为1至7年。在29例患有B2期和C期疾病但应接受而未接受术后放疗的患者中，10例（34%）在盆腔出现复发，另外5例（17%）出现转移性疾病。在接受术后照射的31例患者中，仅2例（6%）出现局部复发，4例（13%）出现远处转移。接受联合治疗的患者3年生存率为80%，而未接受治疗方案中术后部分治疗的患者3年生存率为42%。
