术前,术后放疗的直肠癌治疗中作用的评估和比较

目的：评估和比较辅助性术前、术后放疗在直肠癌治疗中的作用。方法：１９８８年２月～１９９５年２月收治经病理证实的直肠癌１７６例，配合手术分别采用术前单次放疗、术前常规放疗和术后放疗。术前单次放疗组３８例，剂量为５Ｇｙ，并于放疗后４８ｈ内手术；术前４０Ｇｙ常规放疗组４３例，多为临床晚期（Ｔ３～４占６０．５％），中位剂量４０Ｇｙ，放疗后休４周再行手术；术后放疗组９５例，以病变晚期和淋巴结阳性为主（Ｔ３～４占６２．１％，Ｔ２～４Ｎ＋占８１．１％），采用中位剂量５４Ｇｙ常规分割，疗程约６周，手术后３～４周开始接受放疗。结果：全部病例平均随访８４个月，Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算生存率。术前单次放疗组３年、５年局部复发率分别为７８．９％和５０．０％，常规术前４０Ｇｙ放疗组为６７．４％和５１．１％；术后放疗组为５８．９％和

Evaluation and Comparison of Pre- and Postoperative Radiotherapy in Rectal Cancer

Objective:　To evaluate and compare the effects of pre- and postoperative radiotherapy on rectal cancer. Methods:　One hundred and seventy-six cases of histologically proved rectal cancer admitted from February 1988 to February 1995, were divided into 3 groups. Group one: 38 patients(T2:68.4%) were treated with a single fraction preoperative radiotherapy, with a tumor dose of 5 Gy; operation was performed within 48 hours. Group two: 43 patients(T3～4:60.5%) were treated by the conventional preoperative radiotherapy regimen with a median tumor dose of 40Gy in 20 fractions, with a daily dose of 1.8～2Gy, followed by surgery within 4 weeks. Group three: 95 patients(T3～4:62.1%,T2～4N＋:81.1%) underwent postoperative radiotherapy with a median tumor dose of 54Gy in 30 fractions, with a daily dose of 1.8Gy, 3～4 weeks after surgery. Results:　The 3-yr and 5-yr survival rates were: 78.9% and 50.0% in group one, 67.4% and 51.1% in group two, 58.9% and 43.1% in group three. Local recurrence rates were:13.1% and 23.6% , 11.6% and 27.9%, 23.1% and 28.4% in the 3 groups, respectively. Only the 3-yr local recurrence rate of the two preoperative radiotherapy groups were significantly lower than those of the postoperative radiotherapy group (P<0.05). Conclusions:　Compared with the postoperative radiotherapy regimen, preoperative radiotherapy with a proper dosage had better local control and fewer complications.