Frykholm G J, Påhlman L, Glimelius B
Department of Oncology, Akademiska sjukhuset, Uppsala University, Sweden.
Radiother Oncol. 1995 Mar;34(3):185-94. doi: 10.1016/0167-8140(95)01519-m.
From 1978-1992, 159 patients were treated for local recurrences of rectal carcinoma. They could be subdivided into three groups according to the type of primary treatment given; 82 patients underwent primary surgery without irradiation, 37 patients had preoperative and 40 patients postoperative radiotherapy. The localizations of the recurrences and the curative and palliative potentials of surgery and radiotherapy in the treatment of local recurrences were studied. There was no difference in the localisation of the recurrences in the three groups. Median time between initial surgery and recurrence was also almost the same in the three groups and 75% of the recurrences appeared within 2 years. Twenty percent of the patients in the primary surgery alone group, compared with 49% and 38% in the preoperative and postoperative irradiation groups, respectively, had distant metastases at the time of the diagnosis of local recurrence. The predominant symptom from the local recurrence was pain and, after treatment of the recurrence, pain relief was registered in 63%. In 66%, 16% and 22%, respectively, of the patients in the three groups, the intention of the treatment was curative, with either radiotherapy alone, radiotherapy combined with surgery or surgery alone. The 5-years-survival after recurrence was 6% in the primary surgery alone group and 0% in the other 2 groups. Of the 69 patients treated with a curative intention, 32% were locally symptom-free at death or the last follow-up. Our conclusion is that a local recurrence must be avoided due to the morbidity associated with local failure and the potentially low likelihood of curative treatment of a local recurrence.
1978年至1992年期间，159例患者接受了直肠癌局部复发的治疗。根据初次治疗方式，这些患者可分为三组：82例患者接受了单纯初次手术，未进行放疗；37例患者接受了术前放疗；40例患者接受了术后放疗。研究了复发的部位以及手术和放疗在治疗局部复发中的治愈和姑息潜力。三组复发的部位没有差异。三组初次手术与复发之间的中位时间也几乎相同，75%的复发发生在2年内。单纯初次手术组中20%的患者在诊断局部复发时出现远处转移，而术前放疗组和术后放疗组分别为49%和38%。局部复发的主要症状是疼痛，复发治疗后，63%的患者疼痛得到缓解。三组患者中分别有66%、16%和22%的治疗目的是治愈性的，治疗方式分别为单纯放疗、放疗联合手术或单纯手术。单纯初次手术组复发后的5年生存率为6%，其他两组为0%。在69例以治愈为目的接受治疗的患者中，32%在死亡或最后一次随访时局部无症状。我们的结论是，由于局部失败相关的发病率以及局部复发治愈性治疗的可能性较低，必须避免局部复发。
