Hull T L, Lavery I C, Saxton J P
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195.
Dis Colon Rectum. 1994 Dec;37(12):1266-70. doi: 10.1007/BF02257794.
Endocavitary irradiation delivers high-dose irradiation with limited penetration and is an established modality for the curative treatment of select tumors. The purpose of this study was to review the experience from our institution with endocavitary irradiation.
All patients with rectal cancer treated with endocavitary irradiation between 1973 and 1992 were studied. Collected data included: tumor size, tumor differentiation, distance from the anal verge, mean follow-up, recurrence, and other treatments used.
One hundred ninety-nine patients received endocavitary irradiation, with 126 treated with curative intent. No significant differences were found between groups with recurrence and no recurrence when examining tumor size, differentiation, distance from the anal verge, or follow-up. With a mean time to recurrence of 16.1 (range, 1-56) months, 37/126 patients had a recurrence, and 89/126 had no recurrence. Ten recurrences were distant, and all patients died of the disease. Twenty-seven patients had local recurrence. Following additional treatments, 14 additional patients were rendered free of disease.
Endocavitary irradiation initially rendered 71 percent (89/126) free of disease. With additional treatment 11 percent (14/126) were rendered free of disease. In the subgroup of patients followed more than five years, 68 percent had no evidence of disease at follow-up after endocavitary irradiation, and 91 percent had no evidence of disease with additional treatment. Tumor size, differentiation, morphology, and distance from the anal verge did not influence recurrence. Debulking or surgical excision before endocavitary irradiation did not increase recurrence. Diligent long-term follow-up and a liberal policy to biopsy suspicious areas may increase the salvage rate.
腔内照射可在穿透有限的情况下提供高剂量照射，是治疗特定肿瘤的一种既定方式。本研究的目的是回顾我们机构腔内照射的经验。
对1973年至1992年间接受腔内照射治疗的所有直肠癌患者进行研究。收集的数据包括：肿瘤大小、肿瘤分化程度、距肛缘距离、平均随访时间、复发情况以及所采用的其他治疗方法。
199例患者接受了腔内照射，其中126例接受了根治性治疗。在检查肿瘤大小、分化程度、距肛缘距离或随访情况时，复发组和未复发组之间未发现显著差异。平均复发时间为16.1（范围1 - 56）个月，126例患者中有37例复发，89例未复发。10例为远处复发，所有患者均死于该疾病。27例患者有局部复发。经过额外治疗后，又有14例患者无疾病证据。
腔内照射最初使71%（89/126）的患者无疾病证据。经过额外治疗后，11%（14/126）的患者无疾病证据。在随访超过五年的患者亚组中，腔内照射后随访时68%的患者无疾病证据，经过额外治疗后91%的患者无疾病证据。肿瘤大小、分化程度、形态以及距肛缘距离均不影响复发。腔内照射前的减瘤或手术切除并未增加复发率。积极的长期随访以及对可疑区域进行活检的宽松政策可能会提高挽救率。
