Mohiuddin M, Kramer S, Marks G, Dobelbower R R
Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):133-6. doi: 10.1016/0360-3016(82)90398-4.
Since 1976, a new approach to adjuvant radiation therapy in carcinoma of the rectum has been used at Thomas Jefferson University Hospital. Seventy-eight patients with biopsy-proven invasive carcinoma of the rectum have been treated with low dose preoperative radiation, 500 rad given either on the day of or the day before surgery. Following surgery, the lesions were pathologically staged according to Astler-Coller's Modification of Duke's staging. Patients with good prognostic features (Stage A or B1) were followed with no further treatment while patients with poor prognostic characteristics (Stage B2, C1 and C2) were treated with aggressive postoperative pelvic radiation, 4500 rad delivered in five weeks. All patients entered into this study received the preoperative dose of 500 rad. Fifty-six patients underwent an A-P resection, four patients underwent a low anterior resection and ten patients had a combined abdominal transsacral resection. Eight patients were found to have liver metastasis at laparotomy and underwent a colostomy followed by palliative therapy. Twenty-nine patients were found to have early disease, Stage A or B1, and were given no further therapy. Of 41 patients with Stage B2 or C, 25 patients received the full course of postoperative radiation. Sixteen patients did not receive postoperative radiation for a variety of reasons. Follow-up in these patients ranges from six months to a maximum of 48 months with a median follow-up of 18 months. Sixty-nine of the total group of 78 patients are currently alive. Two patients with early tumor (Stage A or B1) have died of metastasis. One other patient with Stage A carcinoma died of unrelated causes. Two of the 25 patients receiving postoperative radiation developed metastatic disease, but none of the patients developed local recurrence in the pelvis. Six of 16 patients who should have received postoperative radiation, but did not recurred. Four of these six recurrences have been in the pelvis. Both the incidence of failure and the pattern of recurrence between these two groups of patients who did not receive postoperative radiation is suggestive of a better effect in the PR unrelated group. Survival of patients treated with this approach appears to be improved.
自1976年以来，托马斯·杰斐逊大学医院采用了一种新的直肠癌辅助放射治疗方法。78例经活检证实为直肠浸润癌的患者接受了低剂量术前放疗，即在手术当天或前一天给予500拉德。术后，根据阿斯特勒 - 科勒对杜克分期的改良对病变进行病理分期。具有良好预后特征（A期或B1期）的患者在无进一步治疗的情况下接受随访，而具有不良预后特征（B2期、C1期和C2期）的患者则接受积极的术后盆腔放疗，在五周内给予4500拉德。所有进入本研究的患者均接受了500拉德的术前剂量。56例患者接受了前后位切除术，4例患者接受了低位前切除术，10例患者进行了联合腹部经骶骨切除术。8例患者在剖腹手术时发现有肝转移，接受了结肠造口术并随后进行了姑息治疗。29例患者被发现患有早期疾病，即A期或B1期，未接受进一步治疗。在41例B2期或C期患者中，25例患者接受了完整疗程的术后放疗。16例患者因各种原因未接受术后放疗。这些患者的随访时间从6个月到最长48个月不等，中位随访时间为18个月。78例患者中的69例目前仍然存活。2例早期肿瘤（A期或B1期）患者死于转移。另1例A期癌患者死于无关原因。25例接受术后放疗的患者中有2例发生了转移性疾病，但没有患者出现盆腔局部复发。16例本应接受术后放疗但未放疗的患者中有6例复发。这6例复发患者中有4例发生在盆腔。这两组未接受术后放疗的患者之间的失败发生率和复发模式表明，在未接受术后放疗的相关组中效果更好。采用这种方法治疗的患者生存率似乎有所提高。
