Wagman R, Minsky B D, Cohen A M, Guillem J G, Paty P P
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 1998 Aug 1;42(1):51-7. doi: 10.1016/s0360-3016(98)00180-1.
To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer.
Thirty six patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (5,T2; 31,T3) involving the distal half of the rectum and clinically required an abdominoperineal resection. The median tumor size was 3.8 cm [range: 1.5-7 cm] and the median distance from the anal verge was 4 cm [range: 3-7 cm]. The whole pelvis received 46.80 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 56 months [range: 4-121 months].
Of the 35 patients who underwent resection, 5 (14%) had a complete pathologic response and 27 (77%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 5-year actuarial: 21%. The 5-year actuarial survival was 64%. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in the 27 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 85%. The median number of bowel movements/day was 2 (range: 0-8).
Our data suggest that preoperative radiation therapy allows sphincter preservation in 77% of selected patients who would otherwise require an abdominoperineal resection, and 85% have good to excellent sphincter function. Given the moderate local failure rate, we now routinely use preoperative combined modality therapy plus postoperative chemotherapy for patients with clinical T3 disease.
确定术前放疗是否能在直肠癌治疗中保留括约肌。
36例诊断为盆腔局限性浸润性、可切除的原发性直肠腺癌患者参加了术前放疗联合低位前切除术/结肠肛管吻合术的I/II期试验。通过术前评估，所有患者均有浸润性肿瘤（5例T2期；31例T3期）累及直肠远端，临床上需要行腹会阴联合切除术。肿瘤中位大小为3.8 cm [范围：1.5 - 7 cm]，距肛缘中位距离为4 cm [范围：3 - 7 cm]。全盆腔接受46.80 Gy照射，随后对原发肿瘤床追加3.60 Gy照射。中位随访时间为56个月[范围：4 - 121个月]。
在35例行切除术的患者中，5例（14%）有完全病理缓解，27例（77%）成功接受了低位前切除术/结肠肛管吻合术。局部失败的粗发病率为17%，5年精算发病率为21%。5年精算生存率为64%。在27例接受低位前切除术/结肠肛管吻合术的患者末次随访时，使用先前发表的量表对括约肌功能进行了分析。85%的患者功能良好或优秀。每日排便中位数为2次（范围：0 - 8次）。
我们的数据表明，术前放疗能使77%原本需要行腹会阴联合切除术的选定患者保留括约肌，且85%的患者括约肌功能良好至优秀。鉴于局部失败率中等，我们现在常规对临床T3期疾病患者采用术前综合治疗加术后化疗。
