Stryker S J, Kiel K D, Rademaker A, Shaw J M, Ujiki G T, Poticha S M
Department of Surgery, Northwestern University Medical School, Chicago, Ill., USA.
Arch Surg. 1996 May;131(5):514-8; discussion 518-9. doi: 10.1001/archsurg.1996.01430170060012.
To determine whether preoperative administration of combination chemotherapy and external beam irradiation ("chemoradiation") for patients with stage II or stage III rectal carcinoma had an impact on perioperative morbidity on oncologic outcome, as compared with patients not receiving preoperative chemoradiation.
A group of patients with stage II or stage III rectal carcinoma receiving preoperative chemoradiation were followed up prospectively and compared in a nonrandomized fashion with an inception cohort group of similar patients.
Northwestern Memorial Hospital, Chicago, Ill, a tertiary care academic medical center.
Thirty patients with rectal carcinoma undergoing preoperative chemoradiation were compared with 56 patients not undergoing preoperative chemoradiation, and also with a subset group of 24 patients who received standard postoperative adjuvant chemoradiation.
External beam radiation, 45 to 50 Gy, was delivered concurrently with fluorouracil and mitomycin 4 to 8 weeks prior to surgical resection.
Patients were followed up at regular intervals for either tumor recurrence or death. In addition, the group receiving preoperative chemoradiation was evaluated for major preoperative morbidity.
All patients agreeing to preoperative chemoradiation completed therapy. Perioperative major morbidity in this group (13%) was comparable to previously published results. Of the 56 patients with stage II or stage III rectal carcinoma not receiving preoperative chemoradiation, only 24 (43%) completed standard postoperative adjuvant chemoradiation. Patients receiving preoperative chemoradiation (n = 30), patients not receiving preoperative chemoradiation (n = 56), and the subset of the group not receiving preoperative chemoradiation who completed standard postoperative chemoradiation (n = 24) were followed up for a mean of 39 months, 31 months, and 32 months, respectively. Five-year actuarial local control rates were 96%, 83%, and 88%, respectively. Disease-free-survival rates were 80%, 57%, and 47%, respectively. Overall survival rates were 85%, 48%, and 78%, respectively.
Preoperative chemoradiation in the treatment of stage II or stage III rectal carcinoma is well tolerated and not associated with an increase in subsequent perioperative major morbidity. In addition, local control, disease-free survival, and overall survival compare favorably with a nonrandomized inception cohort group of patients receiving standard postoperative adjuvant chemoradiation.
与未接受术前放化疗的患者相比，确定术前给予II期或III期直肠癌患者联合化疗和外照射（“放化疗”）是否会对围手术期发病率和肿瘤学结局产生影响。
对一组接受术前放化疗的II期或III期直肠癌患者进行前瞻性随访，并与一组类似患者的起始队列进行非随机比较。
伊利诺伊州芝加哥市的西北纪念医院，一家三级医疗学术医学中心。
将30例接受术前放化疗的直肠癌患者与56例未接受术前放化疗的患者进行比较，并与24例接受标准术后辅助放化疗的亚组患者进行比较。
在手术切除前4至8周，同时给予45至50 Gy的外照射以及氟尿嘧啶和丝裂霉素。
定期对患者进行随访，观察肿瘤复发或死亡情况。此外，对接受术前放化疗的患者组进行主要术前发病率评估。
所有同意接受术前放化疗的患者均完成了治疗。该组围手术期主要发病率（13%）与先前发表的结果相当。在56例未接受术前放化疗的II期或III期直肠癌患者中，只有24例（43%）完成了标准术后辅助放化疗。接受术前放化疗的患者（n = 30）、未接受术前放化疗的患者（n = 56）以及未接受术前放化疗但完成标准术后放化疗的亚组患者（n = 24）的平均随访时间分别为39个月、31个月和32个月。五年精算局部控制率分别为96%、83%和88%。无病生存率分别为80%、57%和47%。总生存率分别为85%、48%和78%。
II期或III期直肠癌治疗中术前放化疗耐受性良好，且与随后围手术期主要发病率增加无关。此外，与接受标准术后辅助放化疗的非随机起始队列患者组相比，局部控制、无病生存率和总生存率表现良好。
