Willett C G, Fung C Y, Kaufman D S, Efird J, Shellito P C
Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston 02114.
J Clin Oncol. 1993 Jun;11(6):1112-7. doi: 10.1200/JCO.1993.11.6.1112.
This study examines the experience of patients treated with postoperative radiation therapy after resection of high-risk colon carcinoma in an effort to assess the potential role of this modality in combination with current systemic therapies.
From 1976 to 1989, 203 patients received postoperative radiation therapy with and without concurrent fluorouracil (5-FU) chemotherapy following resection of modified Astler-Coller B2, B3, C2, and C3 colon tumors. Of the 203 patients, 30 (15%) were identified as having residual local tumor after subtotal resection, whereas 173 (85%) had no known residual disease. The 173 patients treated with adjuvant radiation therapy were compared with a historical control group of 395 patients undergoing surgery only.
Three groups of patients who appeared to benefit from postoperative radiation were identified. Improved local control and recurrence-free survival rates were seen for patients with stage B3 and C3 colon carcinoma treated with postoperative radiation therapy compared with a similarly staged group of patients undergoing surgery only. Irradiated patients whose tumors had an associated abscess or fistula formation had improved local control and recurrence-free survival rates compared with a similar group of patients undergoing surgery only. There appears to be a subset of patients with residual local disease after subtotal resection that may be salvaged by high-dose postoperative radiation therapy.
Selected groups of patients with colon carcinoma may benefit from postoperative radiation in addition to current systemic therapies. Integration of 5-FU and levamisole with postoperative radiation therapy should be considered for patients with (1) stage B3 and C3 lesions, (2) tumors associated with abscess or fistula formation, and (3) residual local disease after subtotal resection.
本研究探讨高危结肠癌切除术后接受术后放疗患者的经历，以评估这种治疗方式与当前全身治疗联合应用的潜在作用。
1976年至1989年，203例患者在切除改良阿斯特勒 - 科勒B2、B3、C2和C3期结肠肿瘤后接受了术后放疗，部分患者同时接受氟尿嘧啶（5-FU）化疗。在这203例患者中，30例（15%）在次全切除术后被确定有残留局部肿瘤，而173例（85%）无已知残留疾病。将173例接受辅助放疗的患者与395例仅接受手术的历史对照组进行比较。
确定了三组似乎从术后放疗中获益的患者。与仅接受手术的相同分期患者相比，接受术后放疗的B3期和C3期结肠癌患者的局部控制和无复发生存率有所提高。与仅接受手术的类似患者组相比，肿瘤伴有脓肿或瘘管形成的接受放疗患者的局部控制和无复发生存率有所提高。似乎有一部分次全切除术后有残留局部疾病的患者可通过高剂量术后放疗挽救。
部分结肠癌患者除当前全身治疗外，可能从术后放疗中获益。对于（1）B3期和C3期病变、（2）与脓肿或瘘管形成相关的肿瘤、（3）次全切除术后有残留局部疾病的患者，应考虑将5-FU和左旋咪唑与术后放疗联合应用。
