Aleman B M, Bartelink H, Gunderson L L
The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur J Cancer. 1995 Jul-Aug;31A(7-8):1333-9. doi: 10.1016/0959-8049(95)00280-v.
During the last two decades, radiotherapy has become an integral part of the multidisciplinary approach in the treatment of patients with colorectal cancer. Currently, radiotherapy is seen mainly as an adjuvant therapy, sometimes in combination with chemotherapy, in a pre- or postoperative setting. Adjuvant radiotherapy alone leads to a significant reduction of local recurrence rates, but an impact on survival is seen only in subset analyses. Combined modality treatment can reduce local recurrence rates even further, and can also reduce the rate of distant relapses and increase survival. The acute toxicity of combined modality is considerably higher. Local radiation can also be use as a component of organ conserving local treatment for selected early lesions. Radiotherapy has been an important palliative treatment modality, diminishing symptoms in cases of inoperable primary rectal cancers or pelvic recurrences. The timing of radiation, surgery and chemotherapy has been under evaluation for years. For patients with locally advanced primary or recurrent malignancies (unresectable due to fixation), the preferred sequence is pre-operative irradiation with or without chemotherapy, followed by surgical resection. For mobile resectable lesions, sequencing issues are being tested in phase III randomised trials.
在过去二十年中，放射治疗已成为结直肠癌患者多学科治疗方法中不可或缺的一部分。目前，放射治疗主要被视为一种辅助治疗，有时在术前或术后与化疗联合使用。单独的辅助放疗可显著降低局部复发率，但仅在亚组分析中观察到对生存率的影响。综合治疗可进一步降低局部复发率，还可降低远处复发率并提高生存率。综合治疗的急性毒性要高得多。局部放疗也可用作某些早期病变保器官局部治疗的一个组成部分。放射治疗一直是一种重要的姑息治疗方式，可减轻无法手术的原发性直肠癌或盆腔复发患者的症状。放疗、手术和化疗的时机多年来一直在评估中。对于局部晚期原发性或复发性恶性肿瘤（因固定而无法切除）患者，首选的顺序是术前放疗，可联合或不联合化疗，然后进行手术切除。对于可移动的可切除病变，正在III期随机试验中测试治疗顺序问题。
