Mella O, Dahl O, Horn A, Morild I, Odland G
Dis Colon Rectum. 1984 Oct;27(10):663-8. doi: 10.1007/BF02553361.
Sixty-seven patients with primary, apparently inoperable rectal adenocarcinomas were referred for radiotherapy from a defined geographic region in Norway during the period from 1976 to 1981. Fifty-five were without detectable metastasis at referral and were potentially resectable. Patients were given high energy radiation towards abdominal chimney or pelvic fields to a dose of 3150 rads. Resection was attempted after three weeks. Additional radiotherapy was given to both resected and nonresected patients to a NSD (nominal standard dose) of 1400 to 1560 ret (rad equivalent therapy). At full radiation dose, nonresected patients were reexamined, and in some explorative laparotomy with resection was attempted. Twenty patients had radical resections in the pelvis, but five of them had moderately advanced distant metastasis. Nine patients are disease-free at 12+ to 76+ months. Although the overall prognosis for the patients with apparently inoperable rectal adenocarcinomas remains poor (median survival 12 months), some patients can achieve long-term disease-free survival after combined radiotherapy and surgery. Patients with moderately advanced metastasis can enjoy a better of quality of life without local symptoms following the combined treatment.
1976年至1981年期间，挪威一个特定地理区域的67例原发性、明显无法手术切除的直肠腺癌患者被转诊接受放疗。转诊时55例未发现转移，有可能进行手术切除。患者接受针对腹部烟囱野或盆腔野的高能辐射，剂量为3150拉德。三周后尝试进行手术切除。对已切除和未切除的患者均给予额外放疗，名义标准剂量（NSD）为1400至1560拉德等效剂量（ret，拉德等效疗法）。在达到全辐射剂量时，对未切除的患者进行复查，部分患者尝试进行探索性剖腹手术并切除肿瘤。20例患者在盆腔进行了根治性切除，但其中5例有中度进展的远处转移。9例患者在12个月至76个月以上无疾病。尽管明显无法手术切除的直肠腺癌患者的总体预后仍然很差（中位生存期12个月），但一些患者在联合放疗和手术后可实现长期无病生存。中度进展转移的患者在联合治疗后可享受无局部症状的更好生活质量。
