Rich T A, Skibber J M, Ajani J A, Buchholz D J, Cleary K R, Dubrow R A, Levin B, Lynch P M, Meterissian S H, Roubein L D
Department of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):1025-9. doi: 10.1016/0360-3016(95)00020-y.
To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer.
Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg/m2/day) together with daily irradiation (45 Gy/25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures.
Posttreatment tumor stages were T1-2, N0 in 35%, T3 N0 in 25%, and T1-3, N1 in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96% (74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99% (76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement (p = n.s.). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor (p = 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone.
Excellent treatment response allowed two-thirds of the patients to have an anal-sphincter-sparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further.
评估术前灌注化疗联合放疗对可手术切除的直肠癌患者的疗效。
对77例临床分期为T3期的直肠癌患者采用术前灌注化疗联合放疗，灌注5-氟尿嘧啶（5-FU）（300mg/m²/天），同时每日放疗（45Gy/25次/5周）。63例患者经内镜超声证实直肠指检结果。化疗放疗结束后约6周进行手术，包括25例腹会阴联合切除术和52例保留肛门括约肌手术。
治疗后肿瘤分期为T1-2、N0的占35%，T3 N0的占25%，T1-3、N1的占11%；29%患者无肿瘤证据。化疗放疗后局部肿瘤控制率为96%（77例中的74例）；2例患者吻合口处复发，经腹会阴联合切除术成功治疗。总体而言，盆腔控制率为99%（77例中的76例）。无淋巴结转移患者化疗放疗后的生存率高于有淋巴结转移患者（p值无统计学意义）。病理完全缓解或仅镜下有病灶的患者比有大体残留肿瘤的患者生存率更高（p = 0.07）。3年精算生存率为83%；中位随访时间为27个月，范围为3至68个月。与单纯传统放疗（XRT）相比，化疗放疗的急性、围手术期和晚期并发症数量和严重程度并未增加。
良好的治疗反应使三分之二的患者能够接受保留肛门括约肌的手术。切除标本中有大体残留病灶表明预后不良，针对这些患者的特异性治疗可能进一步提高生存率。
