Myerson R J
Mallinckrodt Institute of Radiology, Washington University Medical Center, Saint Louis 63110, USA.
Rays. 1997 Jul-Sep;22(3):400-5.
Conservative treatment of rectal cancer with either full thickness en bloc local excision or endocavitary irradiation provides excellent local control for highly selected early rectal carcinomas. For either approach the selection criteria are similar. An ideal lesion should be: 1) freely mobile; 2) less than 3 cm in diameter; 3) no evidence of extension into the perirectal fat either on digital examination or on transrectal US; 4) no clinical evidence of involved nodes on physical examination of diagnostic studies; 5) the surgical alternative would be an abdominal perineal resection; 6) well or moderately differentiated. External beam radiation therapy can contribute to the results of conservative treatment by improving the chances of controlling subclinical nodal disease in the pelvis as well as by improving the control of disease in the rectum at the margins of the local procedure. For highly selected patients, the local control and disease-free interval is on the order of 90% with either endocavitary radiation or local excision.
采用全层整块局部切除或腔内照射对直肠癌进行保守治疗，对于经过严格筛选的早期直肠癌可实现出色的局部控制。对于这两种方法，选择标准相似。理想的病变应具备以下条件：1）可自由移动；2）直径小于3厘米；3）指诊或经直肠超声检查均无证据表明病变已扩展至直肠周围脂肪；4）诊断性检查的体格检查未发现临床证据提示有淋巴结受累；5）手术替代方案为腹会阴联合切除术；6）高分化或中分化。外照射放疗可通过提高控制盆腔亚临床淋巴结疾病的几率以及改善局部手术切缘处直肠疾病的控制情况，来提高保守治疗的效果。对于经过严格筛选的患者，腔内放疗或局部切除后的局部控制率和无病生存期可达90%左右。
