Berger C, Kirscher S, Félix-Faure C, Chauvet B, Vincent P, Brewer Y, Reboul F
Clinique Sainte-Catherine, Chemin du Lavarin, Avignon, France.
Cancer Radiother. 1998 May-Jun;2(3):260-5. doi: 10.1016/s1278-3218(98)80003-6.
To evaluate retrospectively treatment-related morbidity of concurrent radiotherapy and chemotherapy for rectal cancer.
Between 1992 and 1995, 38 patients (median age: 60) were treated for locally advanced resectable rectal cancer. Median dose of radiotherapy was 45 Gy/25 fractions/5 weeks. Chemotherapy consisted of two courses of 5-fluorouracil and leucovorin administered during the first and the fifth weeks of radiotherapy. Median dose of 5-fluorouracil was 350 mg/m2/day, and median dose of leucovorin was 20 mg/m2/day, day 1 to day 5. Surgery was performed 5 weeks after completion of radiotherapy.
Before surgery, one patient died of febrile neutropenia and sepsis after two cycles of chemotherapy and 45 Gy. Main pre-operative grade 3-4 toxicities were respectively: neutropenia: 3%; nausea/vomiting: 3%; diarrhea: 3%; proctitis: 5%; radiation dermatitis: 8%. Twenty-six patients underwent a low anterior resection and 11 an abdomino-perineal resection. A temporary colostomy was performed in 12 patients. Pathologic complete response rate was 27%. There was one post-operative death due to thromboembolic disease. Major post-operative grade 3-4 complications were: pelvic infection: 14%; abdominal infection: 5%; perineal sepsis: 8%; anastomotic dehiscence: 8%; cardiac failure: 5%. Delayed perineal wound healing was observed in six patients. No significant prognosic factor of post-operative complications has been observed. Median duration of hospitalization was 22 days. With a median follow-up of 24 months, 2-year overall and disease-free survival rates were 82 and 64%.
Tolerance of preoperative concurrent chemoradiotherapy was acceptable. Ongoing controlled studies will assess the impact of this combined treatment on survival.
回顾性评估直肠癌同步放化疗的治疗相关发病率。
1992年至1995年间，38例（中位年龄：60岁）局部晚期可切除直肠癌患者接受了治疗。放疗中位剂量为45 Gy/25次/5周。化疗包括在放疗的第一周和第五周给予两个疗程的5-氟尿嘧啶和亚叶酸钙。5-氟尿嘧啶中位剂量为350 mg/m²/天，亚叶酸钙中位剂量为20 mg/m²/天，第1天至第5天。放疗结束后5周进行手术。
手术前，1例患者在接受两个周期化疗及45 Gy放疗后死于发热性中性粒细胞减少症和败血症。主要术前3-4级毒性反应分别为：中性粒细胞减少症：3%；恶心/呕吐：3%；腹泻：3%；直肠炎：5%；放射性皮炎：8%。26例患者接受了低位前切除术，11例接受了腹会阴联合切除术。12例患者进行了临时结肠造口术。病理完全缓解率为27%。有1例患者术后因血栓栓塞性疾病死亡。主要术后3-4级并发症为：盆腔感染：14%；腹部感染：5%；会阴败血症：8%；吻合口裂开：8%；心力衰竭：5%。6例患者出现会阴部伤口延迟愈合。未观察到术后并发症的显著预后因素。中位住院时间为22天。中位随访24个月，2年总生存率和无病生存率分别为82%和64%。
术前同步放化疗的耐受性可以接受。正在进行的对照研究将评估这种联合治疗对生存的影响。
