Mohiuddin M, Regine W F, Marks G J, Marks J W
University of Kentucky, Department of Radiation Medicine, Lexington 40536-0084, USA.
Int J Radiat Oncol Biol Phys. 1998 Feb 1;40(3):569-74. doi: 10.1016/s0360-3016(97)00842-0.
Sphincter-preserving surgery for the management of distal rectal cancer is gaining recognition as an alternative to abdominoperineal resection and loss of anal function. The use of high-dose preoperative radiation appears to enhance the options for sphincter preservation, even in the most distal segments of the rectum.
Seventy patients with tumors located in the distal 2 cm of the rectum received a minimum dose of 40 to 45 Gy over 4 1/2 weeks at 1.8 to 2.5 Gy per fraction. Patients with unfavorable tumors were given an additional boost of 10 to 15 Gy. Surgery was performed 5 to 10 weeks following completion of radiation. Radical surgical resection was performed in 48 patients and full thickness local excision in 22. Follow-up ranged from a minimum of 1 year to a maximum of 10 years, with a median of 4 years.
There was one perioperative mortality. Two patients did not have their colostomy closed because of complications. Late diversion was required in 4 patients, primarily for recurrent disease. Sixty patients (86%) maintained long-term satisfactory sphincter function. Local recurrence was observed in 9 patients (13%) and distant metastases in 12 patients (17%). The overall five-year actuarial survival rate was 82%. The 5-year survival and local recurrence for postradiation pathological stage of disease was: T0, T1, T2, N0--95% and 8%, T3, T4, N0--91% and 4%, T(any) N+--50% and 41%, respectively.
High-dose preoperative radiation, in properly selected patients with rectal cancers of the distal 2 cm, offers opportunities for sphincter-preserving surgical resection with excellent local control, survival, and enhanced quality of life.
保留括约肌的手术治疗低位直肠癌正逐渐被认可为腹会阴联合切除术及肛门功能丧失的替代方案。高剂量术前放疗似乎增加了保留括约肌的选择，即使对于直肠最远端的肿瘤。
70例肿瘤位于直肠远端2 cm的患者在4.5周内接受了至少40至45 Gy的放疗，每次分割剂量为1.8至2.5 Gy。肿瘤情况不佳的患者额外增加10至15 Gy的剂量。放疗结束后5至10周进行手术。48例患者进行了根治性手术切除，22例进行了全层局部切除。随访时间最短1年，最长10年，中位时间为4年。
围手术期死亡1例。2例患者因并发症未关闭结肠造口。4例患者需要晚期改道，主要是因为疾病复发。60例患者（86%）保持了长期满意的括约肌功能。9例患者（13%）出现局部复发，12例患者（17%）出现远处转移。总体五年精算生存率为82%。放疗后疾病病理分期的5年生存率和局部复发率分别为：T0、T1、T2、N0--95%和8%，T3、T4、N0--91%和4%，T（任何）N+--50%和41%。
对于合适选择的直肠远端2 cm癌症患者，高剂量术前放疗为保留括约肌的手术切除提供了机会，可实现良好的局部控制、生存及生活质量的提高。
