Mohiuddin M, Lingareddy V, Marks G
Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
Am J Clin Oncol. 1994 Jun;17(3):264-8. doi: 10.1097/00000421-199406000-00017.
A total of 132 patients with adenocarcinoma of the rectum were treated in a program of "selective sandwich" adjunctive radiation therapy and have been followed for a minimum period of 5 years. All patients were given a single dose of preoperative radiation, 500 cGy, either on the day of or the day before surgery. At surgery, 12 patients with metastatic disease were treated palliatively. The remaining 120 patients underwent radical curative surgery. Patients were then staged histopathologically according to the Astler-Coller modification of Dukes' staging: 34 patients with stage A or B1 disease were followed with no further treatment; 54 patients with stage B2 or C cancer received a planned course of high-dose postoperative radiation (4,500 cGy in 5 weeks); 32 patients with stage B2 and C cancer received no further treatment. Radiation therapy was well tolerated with few long-term side effects. None of the patients receiving low-dose preoperative radiation alone had any complications. Two patients (4%) treated with the combined pre- and postoperative radiation experienced major small bowel complications. Local recurrence was observed in 11 of 32 patients (34%) with stage B2 and C disease receiving low-dose preoperative radiation alone, as compared to 5 of 54 patients (9%) of the combined pre- and postoperative radiation group. The absolute 5-year survival in these two groups is 54% and 72%, respectively. With follow-up now exceeding 5 years, the survival of patients treated with the planned approach of combined pre- and postoperative radiation continues to remain appreciably better than for patients receiving low-dose preoperative radiation alone.
共有132例直肠腺癌患者接受了“选择性夹心”辅助放疗方案的治疗，并已随访至少5年。所有患者在手术当天或手术前一天接受了单次术前放疗，剂量为500厘戈瑞。手术时，12例有转移性疾病的患者接受了姑息治疗。其余120例患者接受了根治性手术。然后根据Dukes分期的Astler-Coller改良版对患者进行组织病理学分期：34例A期或B1期疾病患者在不进行进一步治疗的情况下接受随访；54例B2期或C期癌症患者接受了计划好的高剂量术后放疗疗程（5周内4500厘戈瑞）；32例B2期和C期癌症患者未接受进一步治疗。放疗耐受性良好，长期副作用很少。仅接受低剂量术前放疗的患者均未出现任何并发症。接受术前和术后联合放疗的2例患者（4%）出现了严重的小肠并发症。在仅接受低剂量术前放疗的32例B2期和C期疾病患者中，有11例（34%）出现局部复发，而术前和术后联合放疗组的54例患者中有5例（9%）出现局部复发。这两组的5年绝对生存率分别为54%和72%。随着随访时间超过5年，采用术前和术后联合放疗的计划方法治疗的患者的生存率仍然明显高于仅接受低剂量术前放疗的患者。
