C2期直肠癌术后放疗临床分析

目的分析C2期直肠癌术后放疗的效果,提供今后工作参考.方法回顾分析C2期直肠癌单纯手术和术后配合放疗的病例的生存率和复发率.结果C2期直肠癌术后放疗患者的3,5年生存率分别为51.9%和40.7%比单纯手术提高(31.0%和14.3%)二者有统计学意义(P＜0.05).术后放疗组局部复发率3,5年为18.5%和37.0%,比手术组低(52.4%和71.4%).结论C2期直肠癌患者术后配合放疗可提高生存率及控制复发或转移.但要进一步提高生存率或控制复发、转移还应采用综合治疗的方案.     

直肠癌术后放疗和单纯手术疗效的比较分析

 目的　探讨直肠癌术后追加放疗是否降低局部复发率。方法　全部病例采用Mile’s和Dixon术式 ,并随机分为术后放疗组 5 8例和单纯手术组 4 5例 ;术后放疗组设盆腔后野和两侧野照射 ,照射剂量为 4 5Gy/4 .5～ 5周 ,缩野追加 10～ 15Gy。结果　术后放疗组 5 8例 1/ 2、1、2年的局部复发率为 1.72 %、5 .17%、12 .0 7% ;单纯手术组为 8.89%、17.78%、35 .5 6 % ,两组 1年、2年局部复发率有显著差异。结论　直肠癌手术后放疗组局部复发率显著低于单纯手术组     

30例食管癌术后放疗分析

1996年 1月 - 1998年 2月对 6 4例 期～ 期食管癌进行根治性切除 ,术后对单纯手术和术后放疗者进行 5年生存率的研究 ,其结果具有明显差异 ,现报告如下。1　资料与方法1.1　一般资料6 4例患者中 ,男 5 8例 ,女 6例 ;年龄 38岁～ 72岁 ,平均 5 4 .4 6岁。上段 5例 ,中段 4 1例 ,下段 18例。根治性切除术中经左胸主动脉弓下吻合 9例 ,主动脉弓上吻合 31例 ,胸顶吻合 5例 ;经右胸、上腹部二切口胸顶吻合 14例 ,经右胸、上腹及左颈部三切口颈部吻合 5例。手术后病理诊断鳞癌 6 1例 ,腺癌 2例 ,鳞腺癌 1例。根据国际抗癌联盟 (U ICC)1987年分…     

直肠癌术后放疗（附45例分析）

放疗在直肠癌的综合治疗中占有重要地位,特别是术后预防照射能够起到减少复发提高生存率的作用.本文收集1970年2月至1989年12月治疗的45例直肠癌术后病例:术后预防照射25例和术后复发治疗的20例.两组病例的临床所见和病理检查结果大致相同,前者5年生存率为37%(7/19),后者仅有2例活过3年,可见术后预防照射的预后明显优于复发放疗者.所以对病期偏晚的直肠癌应做预防放疗,可望改善本病的预后.     

直肠癌术前放疗的疗效观察

目的 观察直肠癌术前放疗的临床效果。方法 对28例直肠癌病人进行术前放疗，观察肿块变化情况，不良反应，进行术后随访等。结果 放疗后肿块缩小，保肛率提高、局部复发率降低。结论 术前放疗可以减少复发率，提高切除率，增加保肛率，为直肠癌综合治疗的较佳方式。     

晚期直肠癌的术后放疗

目的评价放疗对晚期直肠癌术后病人的作用。方法从１９９０年１月～１９９３年１２月，我科共收治晚期直肠癌术后放疗病人３２例，年龄最小２８岁，最大６５岁，中位年龄４５岁。所有病例均经病理证实，腺癌３１例，腺鳞癌１例。放疗剂量为４０～５５ＧＹ／４～６周。结果术后与放疗间隔时间１～３个月１５例，复发率２６．７％，３～５个月１７例，复发率４３．７％（Ｐ＜０．０５）。１、３年生存率分别为９０．３％、１９．４％。结论晚期直肠癌术后放疗时间越早越好，并可减少复发率。     

直肠癌术中近距离放疗初探

目的探讨术中近距离放疗对改善低位直肠癌局部控制率的意义。方法对ＤｕｄｅｓＣ期低位直肠癌采用Ｍｉｌｅ’ｓ手术加术中高危复发区或瘤床置管后装放射，６～１０Ｇｙ／次×２和术后盆腔外放射，４０～５８Ｇｙ／４～６周。结果１２例置管３１根，置管治疗成功率９３．５％（２９／３１），中位随访２０个月，置管放射区内无１例复发，４例治疗相关并发症均发生在内、外放射剂量偏高病人。结论本文提示术中置管后装治疗不受解剖部位限制，操作方便且可进行分割放射，可作为低位直肠癌辅助治疗     

直肠癌术前放疗远期疗效分析

本文对1978年10月至1984年4月行根治性手术的244例直肠癌病人随机分成单纯手术和术前放疗两组进行研究。其5年生存率分别为45.1％和61.5％,两组相比较有显著差异,P<0.05。术前放疗组淋巴结转移率为23.8％,明显低于单纯手术组的37.5％,两组相比较P<0.05。术前放疗A、B期病人较单纯手术组高。术前放疗剂量以40—50GY/4～5周为宜,5年生存率为71.4％,明显高于剂量低于40Gy组的44.4％,两组之间有极显著差异,P<0.01。30岁以下直肠癌病人预后不好,粘掖腺癌可不做术前放疗,应争取时间手术根除。     

食管癌放疗后局部复发再程放疗的疗效分析

目的 探讨食管癌放疗后局部复发再放疗的疗效。方法 从1989年2月至1995年10月共对53例食管癌放疗后局部复发再放疗。结果 1，3，5a生存率分别为37．7％，7．5％，5．7％。结论 食管癌放疗后局部复发不宜手术的病人，可行再程放疗。     

直肠癌根治术后辅助性放射治疗的临床研究

目的比较直肠癌根治术后放射治疗与单纯手术的疗效.方法回顾性分析直肠癌根治术后150例.术后放射治疗92例,剂量范围45～50 Gy;单纯手术58例.组间对比及构成比采用χ2检验.结果全组5年总局部复发率22.0%,术后放疗组和单纯手术组局部复发率分别为16.3%和31.0%,术后放疗显著降低了局部复发率(χ2＝4.498,P＜0.05);但是术后放疗组和单纯手术组远处转移率分别为34.8%和22.4%,无显著性意义(P＞0.05).结论直肠癌根治术后放射治疗可降低局部复发率,但不能降低远处转移率.     

Local excision and postoperative radiotherapy for distal rectal cancer

To assess the outcome following local excision and postoperative radiotherapy (RT) for distal rectal carcinoma.

Seventy-three patients received postoperative radiotherapy following local surgery for primary rectal carcinoma at Princess Margaret Hospital from 1983 to 1998. Selection factors for postoperative RT were patient preference, poor operative risks, and “elective” where conservative therapy was regarded as optimal therapy. Median distance of the primary lesion from the anal verge was 4 cm (range, 1–8 cm). There were 24 T1, 36 T2, and 8 T3 lesions. The T category could not be determined in 5. Of 55 tumor specimens in which margins could be adequately assessed, they were positive in 18. RT was delivered using multiple fields by 6- to 25-MV photons. Median tumor dose was 50 Gy (range, 38–60 Gy), and 62 patients received 50 Gy in 2.5-Gy daily fractions. The tumor volume included the primary with 3–5 cm margins. No patients received adjuvant chemotherapy. Median follow-up was 48 months (range, 10–165 months).

Overall 5-year survival and disease-free survival were 67% and 55%, respectively. Tumor recurrence was observed in 23 patients. There were 14 isolated local relapses; 6 patients developed local and distant disease; and 3 relapsed distantly only. For patients with T1, T2, and T3 lesions, 5-year local relapse-free rates were 61%, 75%, and 78%, respectively, and 5-year survival rates were 76%, 58%, and 33%, respectively. The 5-year local relapse-free rate was lower in the presence of lymphovascular invasion (LVI) compared to no LVI, 52% vs. 89%, p = 0.03, or where tumor fragmentation occurred during local excision compared to no fragmentation, 51% vs. 76%, p = 0.02. Eleven of 14 patients with local relapse only underwent abdominoperineal resection, 8 achieved local control, and 4 remained cancer free. The ultimate local control, including salvage surgery, was 86% at 5 and 10 years. The 5-year colostomy-free rate was 82%. There were 2 patients who experienced RTOG Grade 3 late complications, and 1 with Grade 4 complication (bowel obstruction requiring surgery).

The local relapse rate for patients with T1 disease was high compared to other series of local excision and postoperative RT. Patients with LVI or tumor fragmentation during excision have high local relapse rates and may not be good candidates for conservative surgery and postoperative RT.     

三维适形放射治疗局部晚期和术后复发性直肠癌

目的：探讨局部晚期和术后复发性直肠癌三维适形放射治疗（three dimensional conformal radiation therapy,3D-CRT）的临床疗效。方法：60例局部晚期和术后复发性直肠癌均在外照射40Gy后随机分为后程适形放疗组（适形组）30例,常规放疗组（对照组）30例。结果：适形组及对照组有效率分别为86.7%和70.0%,2组差异无统计学意义（P〉0.05）;适形组及对照组1、2、3年生存率分别为80.0%、53.3%、36.7%和56.7%、40.0%、13.3%,P=0.02;1、2、3年局部控制率分别为86.7%、80.0%、50.0%和73.3%、53.3%、30.0%,2组差异均有统计学意义（P=0.0438）;在副反应方面2组差异无统计学意义（P〉0.05）。结论：局部晚期和术后复发性直肠癌常规外照射加三维适形放疗有较好疗效。     

直肠癌术后IMRT±化疗疗效及预后分析

目的 探讨直肠癌术后IMRT±化疗的疗效及预后影响因素。方法 回顾分析2009—2013年间218例直肠癌术后IMRT患者的临床资料。共208例(95.4%)患者进行了化疗, 方案以氟尿嘧啶为主。采用Kaplan-Meier法计算生存率, Logrank检验和单因素预后分析, Cox模型多因素预后分析。结果 随访率97.7%。1、3年OS率分别为90.8%、75.2%, DFS率分别为85.3%、70.5%, LRFS率分别为96.7%、88.1%。全组3—4级急性不良反应发生率为28.4%, 主要表现为3级白细胞减少(13.8%)和腹泻(11.0%)。单因素预后分析表明术前CEA、CA199水平、肿瘤最大径、肿瘤部位、分化程度、肿瘤浸润深度、淋巴结转移数、TNM分期、神经侵犯、手术方式、TME、术前肠梗阻和术前贫血为影响因素(P=0.006、0.000、0.000、0.017、0.000、0.016、0.000、0.011、0.001、0.001、0.006、0.037和0.010);多因素预后分析显示术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为影响因素(P=0.000、0.000、0.000、0.001和0.001)。结论 直肠癌术后IMRT±化疗疗效肯定, 不良反应轻, 治疗依从性较高。术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为预后影响因素。     

Pelvic insufficiency fractures after preoperative radiotherapy for rectal carcinoma

Insufficiency fractures of the pelvic bones are rare complications of radiotherapy, but they can cause significant morbidity. We report a patient who developed pelvic insufficiency fractures because of preoperative hypofractionated radiotherapy with chemotherapy for rectal carcinoma. She was treated with a four-field box technique, receiving 20Gy in four fractions, and she underwent concurrent pharmacokinetic modulating chemotherapy (PMC; intravenous infusion of 5-fluorouracil [FU], 750mg/body per 24h and oral administration of uracil and futrafur [UFT] 400mg/day) over a 1-week period. She developed severe buttock and femoral pain 10 months after this preoperative therapy. Physical examination at this time was unremarkable, with an absence of neurological signs, and radiographic examination was also normal, resulting in the patient initially being undiagnosed. However, 2 months after the onset of her initial pain, she was diagnosed as having pelvic insufficiency fractures on conventional radiographs. Although preoperative chemoradiotherapy has been widely accepted for improving local control and survival in patients with primary rectal carcinoma, surgeons need to be aware of this rare complication that can arise even 10 months after preoperative chemoradiotherapy.     

Epidermal growth factor receptor is a predictor of tumor response in locally advanced rectal cancer patients treated with preoperative radiotherapy

Epidermal growth factor receptor (EGFR) expression is observed in 50%–70% of colorectal carcinomas and is associated with poor prognosis. The aim of this study was to determine the EGFR expression rate in locally advanced rectal cancer and to analyze whether EGFR expression predicts tumor response to preoperative radiotherapy.

Between December 1997 and October 2000, 45 patients were included. Treatment consisted of preoperative pelvic radiotherapy and, in 21 patients, 2 courses of 5-fluorouracil leucovorin. Surgical resection was performed 4–8 weeks later. Immunohistochemistry for EGFR was determined at the preradiation diagnostic biopsy and in the resected specimens. Immunostaining was performed using EGFR monoclonal antibody (Biogenex, MU 207-UC). Immunohistochemical staining was evaluated according to extension and intensity. We defined positive staining (EGFR+) as extension of 5% or more.

Preoperative treatment resulted in pathologic complete remission in 7 patients (15%), downstaging in 13 patients (29%), and no response in 25 patients (56%). EGFR+ was observed in 29 of 45 tumors (64%) and was associated with neither clinical tumor stage nor clinical nodal stage. The overall response rate was 34% in EGFR+ patients vs. 62% in those who were EGFR− (p = 0.07). Only 1 of the 7 pathologic complete remission patients was EGFR+ (p = 0.003).

EGFR is expressed in a significant number of locally advanced rectal tumors. EGFR expression is an indicator for poor response to preoperative radiotherapy in advanced rectal carcinoma.     

局部晚期直肠癌三维适形放疗同期化疗后pCR患者术后辅助化疗的价值

目的 探讨局部晚期直肠癌术前三维适形放疗同期化疗后病理完全缓解(pCR)患者术后辅助化疗的价值。
方法 2005-2010年本中心收治的同期放化疗后术后病理证实pCR的 49例患者,其中行术后辅助化疗 38例,未行术后辅助化疗 11例。比较二者疗效。
结果 随访率100%,随访时间满 3年者 22例。全组 3年总生存率、无复发生存率和癌症特异生存率分别为92%、90%和95%,术后有与无辅助化疗的分别为90% 与100%(χ²=0.05,P=0.818)、92%与80%(χ²=1.00,P=0.316)、94%和100%(χ²=0.31,P=0.581)。全组 3年复发率为8%,术后有、无辅助化疗的分别为8%、9%(χ²=1.00,P=0.316)。
结论 局部晚期直肠癌术前三维适形放疗同期化疗后获pCR患者累计复发率低,术后辅助化疗并未提高疗效,因随诊期短、病例数不多,其价值需进一步临床随机对照研究加以甄别。     

改进型腹板在直肠癌术后放疗中的应用

目的 简述改进型腹板在直肠癌术后放疗中的应用方法,并探讨其对摆位重复性的影响.方法 对改进型腹板的应用方法进行说明,运用锥形束CT对使用常规型腹板、改进型腹板放疗患者的分次内及分次间摆位误差分别进行测量,并对数据进行分析,得出结论.结果 运用常规型腹板患者分次内摆位误差在x轴差异无统计学意义（P＞0.05）,在v、z轴差异均有统计学意义（均P＜0.05）;分次间摆位误差在x轴差异无统计学意义（P＞0.05）,在v、z轴上差异均有统计学意义（均P＜0.05）.运用改进型腹板患者分次内摆位误差及分次间摆位误差在x、v、z轴上差异均无统计学意义（均P＞0.05）.结论 运用改进型腹板固定对摆位误差重复性的控制方面比常规型腹板更具有优势,有利于提高患者治疗的准确性.     

The effect of time interval from chemoradiation to surgery on postoperative complications in patients with rectal cancer

BackgroundA prolonged time interval between chemoradiation and total mesorectal excision (TME) may render more rectal cancer patients eligible for organ-sparing approaches but may also cause more pelvic fibrosis and surgical morbidity. We estimated the effect of time interval on postoperative complications and other surgical outcomes in rectal cancer patients.MethodsThis is a population-based cohort study using data of the Dutch Colorectal Audit. Rectal cancer patients treated with chemoradiation followed by TME after an interval of 3–20 weeks were selected (n = 6,268). Time interval from completion of chemoradiation to TME was categorized into 3–6, 7–8, 9–10, 11–12 and 13–20 weeks. Outcomes included postoperative complication (any, and stratified by medical and surgical complications), reintervention, intraoperative complication, incomplete resection, positive circumferential margin (CRM) and pathological complete response (pCR). The interval of 7–8 weeks was the reference group.ResultsProlonged time intervals were not associated with a higher risk of a postoperative complication (any, surgical or medical), reintervention, and incomplete resection. Intraoperative complications were however more common after 11–12 weeks than after 7–8 weeks (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.20–2.69). The interval of 9–10 weeks was associated with less CRM positive resections, and 9–10 and 13–20 weeks with more pCR (relative to 7–8 weeks, OR = 0.74, 95%CI = 0.56–0.98; OR = 1.28, 95%CI = 1.04–1.58; and OR = 1.33, 95%CI = 1.04–1.71, respectively).ConclusionsCompared with 7–8 weeks, longer time intervals up to 13–20 weeks between chemoradiation and TME are not associated with more postoperative complications or more positive resection margins. Accordingly, prolonging the interval aiming for organ-sparing treatment is safe.