直肠腺癌根治术后放射治疗的疗效分析

目的 分析局部晚期直肠癌术后放射治疗疗效。方法 回顾性分析行直肠癌根治术后、无远处转移的Ⅱ、Ⅲ期直肠腺癌180例。手术加术后放射治疗138例，照射剂量40Gy-60Gv，中位剂量50cGy；单纯手术42例。生存分析采用Kaplan-Meier法及Logrank法检验。结果 全组5年总生存率为56．8％，无瘤生存率为53．9％。术后接受放射治疗组和单纯手术组5年总生存率分别为60．9％和56．7％。5年无瘤生存率分别为63．5％和54．6％，其生存率差异均无显著性意义（P=0．581，P=0．378）。但术后放射治疗使局部复发率明显降低，其与单纯手术组的5年累积局部区域复发率分别为16．6％和29．6％（P=0．047）。结论 Ⅱ、Ⅲ期直肠腺癌术后放疗可提高局部控制率，但不能使生存期延长。     

Ⅱ和Ⅲ期直肠癌根治术后放射治疗的疗效观察

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 回顾性分析可手术切除、无远地转移的Ⅱ、Ⅲ期直肠癌243例。手术加术后放射治疗192例，剂量范围32～62Gy，中位剂量50Gy；单纯手术51例。生存分析采用Kaplan-Meier法及Logrank法检验。结果 全组5年总生存率和无瘤生存率分别为60．3％和58．3％。术后放射治疗组和单纯手术组5年总生存率分别为59．4％和64．7％，其相应无瘤生存率分别为57．0％和66．4％，其生存率差异均无显著性意义(P=0．601，P=0．424)。但术后放射治疗使局部复发率明显降低，其与单纯手术组的5年累积复发率分别为15．8％和26．8％(P=0．043)。结论 Ⅱ、Ⅲ期直肠癌术后放射治疗可提高局部控制率，不能延长生存期。     

直肠癌根治术后局部复发的放射治疗

目的探讨直肠癌根治术后局部复发的放疗疗效.方法回顾我科1992年3月～1999年12月间收治的42例直肠癌复发病例.采用60Co-r线及10mvx线前后对穿野;后一侧二三野;会阴野等方法照射.DT180～200CGY/F,DT总 4 000～6000CGY/4～7w.结果症状缓解率93%,完全消失14%.放疗后肿块缩小的病例占42%,结论采用放射治疗可以明显减轻直肠癌术后复发病人的症状,提高生存质量.     

直肠癌的放射治疗

自从1908年Miles开创了直肠癌手术的新纪元，长达半个多世纪以来直肠癌的主要治疗手段仍以手术为主，近30年来尽管外科和麻醉技术有了很大发展，但其远期疗效无明显提高。单纯手术治疗各期平均五年生存率仍停留在50％左右，手术治疗失败的原因主要是局部复发和远处转移。     

TAI联合放射治疗晚期直肠癌的临床研究

目的探讨经直肠下动脉介入化疗(TAI)方案联合放射治疗晚期直肠癌的疗效及毒副反应。方法回顾分析68例晚期直肠癌的随访资料,根据治疗方法不同分为TAI联合放射治疗组和单纯放疗组,分析肿瘤的缓解率、患者的生存率及毒副反应。结果TAI方案联合放疗组在肿瘤的消失、缩小方面优于单纯放疗组,两者差异有显著意义(P<0.05)。TAI组联合放疗组1、2、3年的生存率明显高于单纯放疗组,两者有显著性差异(P<0.05);5年生存率相近,但TAI组联合放疗组较单纯放疗组消化道I~II度毒副反应发生率明显增加,差异有显著性意义(P<0.05)。结论TAI方案联合放射治疗能提高局控率,降低复发率,减少局部淋巴和远处转移率,有效提高长期生存率,且并发症发生率较低,是一种简单、安全、较理想的中晚期直肠癌的治疗方案,有临床推广价值。     

局部晚期直肠癌的术前同步放射治疗和化疗

目的 观察１５例局部晚期直肠癌术前放射治疗和化疗（术前放化组）后外科手术的结果，以同期２７例直肠癌术前放射治疗加手术治疗作为对照组，分析其疗效及毒副反应。方法 １５例局部晚期直肠癌予术前放射治疗（ＤＴ４０～４６Ｇｙ，２０～２３次，４～５周完成）加同步化疗（氟尿嘧啶加甲酰甲氢叶酸钙静脉滴注和脱氧氟尿苷口服），对照组为同期２７例局部晚期直肠癌，予术前放射治疗，ＤＴ４０～５０Ｇｙ，２０～２５次，４～５周     

直肠癌的辅助性放化疗

１９９０年全世界估计有４３７０００人死于结直肠癌犤１犦。世界范围内大肠癌是最常见的恶性肿瘤之一。在欧洲，大肠癌是位居第二的常见肿瘤，国内近年来大肠癌的发病率亦呈上升趋势。迄今为止，外科在大肠癌的治疗中仍占主导地位。但是，单纯手术后，局部复发率仍很高。直肠癌辅助治疗的疗效已成不争的事实。直至上世纪末，临床上尚未形成统一的“标准”辅助治疗方案。欧美之间，欧洲各国之间，甚至同一国家的不同机构治疗方案亦不相同，国内情况亦如此。直肠癌辅助放疗的临床应用已经讨论了３０年以上。放疗可以于手术前、术中或者手术后…     

三维适形放射治疗20例复发性直肠癌

目的 探讨三维适形放射治疗对复发性直肠癌的临床疗效。方法 20例复发性直肠癌患者均采用三维适形放疗，3～4Gy／次，隔日1次，总剂量48～60Cy。结果1、2、3年生存率分别为40％（8／20），15％（3／20），5％（1／20）。结论 三维适形放射治疗可提高复发性直肠癌生存率，改善生存质量。     

直肠癌术后盆腔内复发的放射治疗

目的探讨放射治疗对复发性直肠癌的治疗效果。方法４４例复发性直肠癌,１９例行手术切除,２５例行放射治疗,剂量４０～７０Ｇｙ,常规分割方法。结果照射后会阴部疼痛、出血症状均有减轻,乃至消失,会阴部肿块照射后缩小１／２以上者占５５％（５／９）。放疗组１年生存率５２％、３年生存率１６％,好于手术组的４２．１％、１０．５％。结论放射治疗在直肠癌术后复发的治疗中起到减轻症状、使肿瘤缩小、延长生存期作用,照射剂量不宜低于６０Ｇｙ。     

早期乳腺癌根治术或改良根治术后放射治疗的策略

早期乳腺癌根治术或改良根治术后的放射治疗日益受到重视,其对术后生存率的影响及不同的治疗策略在预防复发和转移中的作用正在引起广泛的讨论.     

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。     

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.     

pT3N0期直肠癌术后辅助放疗价值探讨

目的 探讨pT₃N₀期直肠癌根治性切除术后辅助放疗价值。方法 回顾分析2003-2010年期间本院诊断明确且行TME术的 125例pT₃N₀期直肠癌患者资料,所有患者均接受术后化疗,其中 40例接受术后放疗。Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析,Cox法多因素分析影响LR因素。结果 5年样本量为 35例,5年OS和DFS分别为 82.3%和72.4%,术后放化疗和化疗的 5年OS分别为72%和83%(P=0.911)。多因素分析送检淋巴结个数、肿瘤是否侵犯肠周脂肪是LR的影响因素(P=0.045、0.021)。低危组(无高危因素)和高危组(≥1个) LR率分别为2.5%和11.8%(P=0.060)。结论 对于无高危因素的pT₃N₀期直肠癌患者术后放疗未能改善OS、LR率,对该期患者术后常规放疗有待探讨。     

直肠癌术前放射治疗临床分析

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.     

216例Dukes C期直肠癌术后放疗疗效分析

目的:分析直肠癌术后放疗的疗效及预后因素.方法:1983年1月～1992年12月收治直肠癌术后放疗216例.采用~(60)CO或15MV X线外照射,剂量DT13.6～80Gy,DT45Gy以上采用缩野技术,疗程9～147天.前后野剂量比大多数为1:2.结果:总的5年生存率为33.8%(73/216).10年生存率为8.8%(19/216).术后放疗组5年生存率为51.5%(68/132),复发后放疗5年生存率为6.0%(5/84),两者差异有显著意义(P<0.05).其中156例已死亡病例中术后放疗与复发后放疗死于局部复发或复发未控制分别为34.4%与66.7%,死于血行转移分别为65.6%与33.3%,有显著差异.结论:C期直肠癌术后应常规行术后放疗,适宜剂量DT45～60Gy,疗程直<50天.复发患者应及时确诊,尽早放疗,剂量充足.     

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。     

Multicenter dose-finding study of concurrent capecitabine and radiotherapy as adjuvant treatment for operable rectal cancer

PURPOSE: 5-Fluorouracil-based chemotherapy with concurrent radiotherapy (RT) is the standard adjuvant treatment in rectal cancer. A Phase I study was conducted to determine the maximal tolerated dose and the dose-limiting toxicities of capecitabine combined with standard RT as adjuvant treatment in patients with rectal cancer. METHODS AND MATERIALS: Patients with Stage II-III rectal cancer after surgery were eligible. RT included a total dose of 50.4 Gy in fractions of 1.8 Gy/d, 5 d/wk, for 5.5 weeks. Capecitabine was administered twice daily in escalating doses during the entire period of RT. Dose-limiting toxicity included Grade 4 neutropenia or thrombocytopenia, febrile neutropenia, Grade 3 or greater nonhematologic toxicity, or treatment delay because of unresolved toxicity for >1 week. RESULTS: Thirty-one patients were enrolled at the following dose levels: 1000 mg/m(2)/d (3 patients), 1150 mg/m(2)/d (4 patients) 1300 mg/m(2)/d (6 patients), 1400 mg/m(2)/d (6 patients), 1500 mg/m(2)/d (3 patients), 1600 mg/m(2)/d (3 patients), and 1700 mg/m(2)/d (6 patients). Dose-limiting toxicities were observed in 2 patients at 1300 mg/m(2)/d (Grade 3 diarrhea), and 2 patients at 1400 mg/m(2)/d (skin toxicity in 1 and abdominal pain with fever in 1, resulting in treatment delay), and 3 patients at 1700 mg/m(2)/d (2 patients had Grade 3 diarrhea and 1 had hand-foot syndrome). Four patients presented with chronic postradiation colitis. CONCLUSIONS: The maximal tolerated dose of capecitabine given concurrently with RT was 1600 mg/m(2)/d in this study. This dose is recommended for additional use in Phase II-III studies.     

Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer

PURPOSE: To identify patterns of locoregional recurrence in patients treated with surgery and preoperative or postoperative radiotherapy or chemoradiation for rectal cancer. METHODS AND MATERIALS: Between November 1989 and October 2001, 554 patients with rectal cancer were treated with surgery and preoperative (85%) or postoperative (15%) radiotherapy, with 95% receiving concurrent chemotherapy. Among these patients, 46 had locoregional recurrence as the first site of failure. Computed tomography images showing the site of recurrence and radiotherapy simulation films were available for 36 of the 46 patients. Computed tomography images were used to identify the sites of recurrence and correlate the sites to radiotherapy fields in these 36 patients. RESULTS: The estimated 5-year locoregional control rate was 91%. The 36 patients in the study had locoregional recurrences at 43 sites. There were 28 (65%) in-field, 7 (16%) marginal, and 8 (19%) out-of-field recurrences. Among the in-field recurrences, 15 (56%) occurred in the low pelvis, 6 (22%) in the presacral region, 4 (15%) in the mid-pelvis, and 2 (7%) in the high pelvis. Clinical T stage, pathologic T stage, and pathologic N stage were significantly associated with the risk of in-field locoregional recurrence. The median survival after locoregional recurrence was 24.6 months. CONCLUSIONS: Patients treated with surgery and radiotherapy or chemoradiation for rectal cancer had a low risk of locoregional recurrence, with the majority of recurrences occurring within the radiation field. Because 78% of in-field recurrences occur in the low pelvic and presacral regions, consideration should be given to including the low pelvic and presacral regions in the radiotherapy boost field, especially in patients at high risk of recurrence.     

低位直肠癌保肛术后辅助放疗的价值

目的:探讨手术后辅助放射治疗对低位直肠癌保肛患者局部肿瘤复发的影响。方法:84例低位直肠癌保肛患者,分为单纯手术组和术后放疗组各42例。术后放疗组于术后半月行全盆腔常规方法分割照射治疗,照射总剂量为5000cGy。比较两组的局部复发率。结果:随访4年,术后放疗组和单纯手术组肿瘤局部复发率分别为14.3%和38.9%(P<0.05)。结论:对低位直肠癌保肛患者,术后进行辅助放疗有助于降低肿瘤局部复发。     

122例老年直肠癌患者外科治疗的临床分析

背景与目的:老年直肠癌患者常常合并其他疾病,其手术方案的选择需要综合考虑各种因素。本研究的目的是探讨65岁以上老年直肠癌患者的治疗方案及影响其预后的因素。方法:回顾性分析中国医学科学院肿瘤医院1987年1月至1998年12月间收治的122例老年直肠癌患者的临床资料。全组患者均经手术治疗,其中腹会阴联合根治术45例,直肠前切除术66例,Hartmann术7例,经肛直肠癌局部切除术4例。术后发生并发症者10例(8.2%),无术后30天内死亡病例。采用Kaplan-Meier法进行生存分析,log-rank检验进行统计学比较;应用Cox比例风险模型进行多因素分析。结果:全组总的3年及5年生存率分别为76.4%、61.0%。无淋巴结转移组(DukesA、B期)3年及5年生存率分别为81.6%、70.6%,有淋巴结转移组(DukesC期)分别为60.9%、40.4%,两组比较有显著性差异(χ2=10.1,P<0.01)。直肠癌的组织学类型、肿瘤大小及是否合并其它脏器疾病等因素对预后没有显著性影响(P>0.05)。Cox比例风险模型分析表明淋巴结转移状况是影响预后的重要独立因素。结论:老年直肠癌患者经合理的围手术期处理,大多能耐受手术,并可获长期生存;淋巴结转移状况是影响其预后的重要因素。