Coia L, Wizenberg M, Hanlon A, Gunderson L, Haller D, Hoffman J, Kline R, Mohiuddin M, Russell A, Tepper J
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111.
J Clin Oncol. 1994 May;12(5):954-9. doi: 10.1200/JCO.1994.12.5.954.
For the first time, a Patterns of Care Study (PCS) was conducted in 1989 to determine the national practice standards of radiation oncologists in evaluating and treating adenocarcinoma of the rectum and sigmoid colon.
A national survey of 73 institutions using two-stage cluster sampling was conducted, and specific information on 408 patients from 69 facilities with adenocarcinoma of the rectum and sigmoid colon who received radiation as part of definitive or adjuvant management was collected.
Using the modified Astler-Coller (MAC) pathologic staging system, the stage distribution was as follows: A, 0.5%; B1, 4.4%; B2, 23.5%; B3, 5.1%; C1, 8.9%; C2, 30.2%; and C3, 6.6%. Preoperative radiation was used in 29% of patients, but the total dose was greater than 40 Gy in only 20%. Seventy-three percent of patients received postoperative radiation, with approximately 4% receiving combined preoperative and postoperative radiation. Chemotherapy was administered to 44% of patients overall, representing 55% of patients with disease through the bowel wall and/or involving lymph nodes. Only 37% of all patients received chemotherapy concurrent with radiation. An abdominoperineal resection was used in 43%; a low anterior resection was used in 43% as well, while 5% underwent other types of bowel resection. Approximately 8% of patients were treated with a local curative procedure less than bowel resection (eg, local excision, endoscopic resection, fulguration, or contact radiation). At least one third of patients had interruption in their pelvic irradiation of greater than 3 days. There was no statistically significant difference in the frequency of treatment interruptions by dose per fraction or whether chemotherapy was given concurrent with radiation. There was no significant difference in total dose delivered to patients staged B2 and higher treated without chemotherapy compared with concurrent chemotherapy and radiation. Also, there was no significant difference in total dose delivered to patients with B1 and B2, or C1 and C2 versus B3 or C3 cancer.
This study was conducted on patients treated just before the 1990 National Institutes of Health consensus guidelines issued on the management of colon and rectal cancer. This study indicates that the minority of patients treated with radiation in 1988 and 1989 received concurrent chemoradiation, as currently recommended. Additionally, insofar as present studies are investigating important issues such as the use of sphincter-sparing procedures, preoperative radiation and chemotherapy, and the importance of radiation dose and scheduling with chemotherapy, the information provided by this study will serve as a useful baseline to track future changes in rectal cancer evaluation and management.
1989年首次开展了一项治疗模式研究（PCS），以确定放射肿瘤学家在评估和治疗直肠及乙状结肠癌腺癌方面的全国实践标准。
采用两阶段整群抽样法对73家机构进行了全国性调查，收集了来自69家机构的408例直肠及乙状结肠癌腺癌患者的具体信息，这些患者接受了放射治疗作为根治性或辅助性治疗的一部分。
采用改良的阿斯特勒 - 科勒（MAC）病理分期系统，分期分布如下：A期，0.5%；B1期，4.4%；B2期，23.5%；B3期，5.1%；C1期，8.9%；C2期，30.2%；C3期，6.6%。29%的患者接受了术前放疗，但总剂量大于40 Gy的仅占20%。73%的患者接受了术后放疗，约4%的患者接受了术前和术后联合放疗。总体而言，44%的患者接受了化疗，在肿瘤穿透肠壁和/或累及淋巴结的患者中这一比例为55%。所有患者中只有37%在放疗的同时接受了化疗。43%的患者采用了腹会阴联合切除术；43%的患者采用了低位前切除术，5%的患者接受了其他类型的肠道切除术。约8%的患者接受了小于肠道切除术的局部根治性手术（如局部切除、内镜切除、电灼或接触放疗）。至少三分之一的患者盆腔放疗中断超过3天。按每次分割剂量或是否同时进行化疗来划分，治疗中断的频率没有统计学上的显著差异。在未接受化疗与同时接受化疗和放疗的情况下，B2期及以上分期患者所接受的总剂量没有显著差异。同样，B1期和B2期、C1期和C2期患者与B3期或C3期癌症患者所接受的总剂量也没有显著差异。
本研究是针对在1990年美国国立卫生研究院发布关于结肠癌和直肠癌管理的共识指南之前接受治疗的患者进行的。该研究表明，1988年和1989年接受放疗的患者中，少数患者按照目前推荐的方式接受了同步放化疗。此外，鉴于目前的研究正在调查诸如保留括约肌手术的使用、术前放疗和化疗以及放疗剂量和化疗时间安排的重要性等重要问题，本研究提供的信息将作为跟踪未来直肠癌评估和管理变化的有用基线。
