直肠癌术前放射治疗临床分析  

Clinical study on pre-operative radiotherapy for rectal cancer

作　　者：牛道立[1] 胡慧玲[2] 卫洪波[3] 

机构地区：[1]广州医学院第一附属医院放疗科,广州510120 [2]河南科技大学附属医院X刀中心 [3]中山大学第三附属医院普外科

出　　处：《中国肿瘤临床与康复》2004年第5期416-418,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的 探讨直肠癌术前放射治疗的疗效及在直肠癌治疗中的价值。方法 1995年6月至1998年6月收治Ⅱ-Ⅲ期直肠癌患者78例,随机分为术前放疗组和单纯手术组,每组39例。采用常规放疗方法,剂量为DT 50 Gy/5周,照射后4-5周行根治性手术。结果 术前放疗组术后病理检查肿瘤细胞呈轻度反应者4例,中度反应者15例,重度反应者17例,肿瘤细胞消失者3例;临床分期变化:T期下降17例,占43.6％,N期下降7例,占33.3％。术前放疗组和单纯手术组的淋巴结转移率分别为15.4％和35.9％,差异有显著性(P=0.039);术前放疗组和单纯手术组的术后复发率分别为17.9％和41.0％,差异有显著性(P=0.015);术前放疗组和单纯手术组3,5年生存率分别为76.9％、53.8％和59.0％、35.9％,差异有显著性(P=0.034)。术前放疗组的急性放疗反应可耐受,亦未出现由放疗造成的远期并发症。结论 术前放疗可降低直肠癌的局部复发率,提高患者的生存率;急性放疗反应可耐受,并不增加手术难度及并发症。Objective To evaluate the efficacy of pre-operative radiotherapy in treatment of rectal cancer. Methods From June 1995 to June 1998,78 patients with stage-Ⅱ to stage-Ⅲ rectal cancer were randomly divided into two groups.Thirty-nine patients received pre-operative radiotherapy and the others received operation alone. The pre-operative radiotherapy group received conventional radiotherapy, with total tumor dose (TD) of 50 Gy/ Sweeks.Operation was performed 4-5 weeks after the radiation. Results In pre-operative radiotherapy group, 4 cases had slight pathologic response, 15 cases middle pathologic response, 17 cases severe pathologic response and 3 cases complete pathologic response.T-stage was lowered in 17(43.6%) of 39 patients. N-stage was lowered in 7 (33.3%) of 21 patients. The lymphatic metastasis rates of pre-operative radiotherapy group and operation alone group were 15.4% and 35.9% (P = 0.039) , the local recurrence rates of pre-operative radiotherapy group and operation alone group were 17.9% and 41.0%(P = 0.015) ,and the 3-and 5-year survival rates of pre-operative radiotherapy group and operation alone group were 76.9% ,53.8% and 59. 0% , 35. 9% respectively ( P = 0.034) .The acute toxicity of pre-operative radiotherapy group was acceptable without increasing operative difficulty and complications. Conclusions Pre-operative radiotherapy is able to reduce the local recurrence rate and improve the 3-and 5-year survival rates of patients with stage-Ⅱ to stage-Ⅲ rectal cancer. The acute radiation toxicity was tolerable without increasing operative difficulty and complications.

关 键 词：结直肠肿瘤 术前放疗 预后 

分 类 号：R735.37[医药卫生—肿瘤] R730.55[医药卫生—临床医学]