Minsky B D, Coia L, Haller D G, Hoffman J, John M, Landry J, Pisansky T M, Willett C, Mahon I, Owen J, Berkey B, Katz A, Hanks G
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 1998 Jul;16(7):2542-7. doi: 10.1200/JCO.1998.16.7.2542.
To determine the US national practice standards for patients with adenocarcinoma of the rectum treated in radiation oncology facilities.
A national survey of 57 institutions identified 507 eligible patients who received radiation therapy as a component of their treatment for rectal cancer. A stratified two-stage cluster sampling with simple random sampling at each stage for each stratum was used and on-site surveys were performed.
Of the 507 patients, 378 (75%) received postoperative therapy, 110 (22%) received preoperative therapy, 17 (2%) received both preoperative and postoperative therapy, and less than 0.5% received intraoperative radiation alone. To more accurately assess the utilization of modern radiation techniques as well as recommendations of the National Cancer Institute (NCI)-sponsored, randomized, postoperative, adjuvant combined modality therapy rectal cancer trials into current practice, the analysis was limited to the 243 (48%) patients with tumor, node, and metastasis staging system classification T3 and/or N1-2M0 disease who underwent conventional surgery with negative margins. Although only 7% were treated on a clinical trial, 90% received chemotherapy for a median of 21 weeks. Most were treated with modern radiation treatment techniques. In contrast, techniques to identify and help exclude the small bowel from the radiation field were not routinely used.
Despite the fact that only 7% of patients with T3 and/or N1-2M0 disease were treated on a clinical trial, such trials appear to have resulted in a positive influence on the standard of practice within the oncology community. Although there are still some deficiencies, the majority of these patients received combined modality therapy and were treated with modern radiation therapy techniques.
确定美国放射肿瘤学机构中接受治疗的直肠癌腺癌患者的全国性实践标准。
对57家机构进行的全国性调查确定了507例符合条件的患者，他们接受放射治疗作为直肠癌治疗的一部分。采用分层两阶段整群抽样，每个阶层在每个阶段进行简单随机抽样，并进行现场调查。
在507例患者中，378例（75%）接受了术后治疗，110例（22%）接受了术前治疗，17例（2%）接受了术前和术后治疗，不到0.5%的患者仅接受术中放疗。为了更准确地评估现代放射技术的应用情况，以及将美国国立癌症研究所（NCI）赞助的随机、术后、辅助联合模式治疗直肠癌试验的建议纳入当前实践，分析仅限于243例（48%）肿瘤、淋巴结和转移分期系统分类为T3和/或N1-2M0疾病且接受切缘阴性的传统手术的患者。尽管只有7%的患者参加了临床试验，但90%的患者接受了中位时间为21周的化疗。大多数患者接受了现代放射治疗技术。相比之下，识别并帮助将小肠排除在放射野之外的技术并未常规使用。
尽管只有7%的T3和/或N1-2M0疾病患者参加了临床试验，但这些试验似乎对肿瘤学界的实践标准产生了积极影响。尽管仍存在一些不足，但这些患者中的大多数接受了联合模式治疗，并采用了现代放射治疗技术。
