术前放疗联合全直肠系膜切除术治疗可切除性直肠癌临床疗效的系统评价

Efficacy of preoperative radiotherapy combined with total mesorectal excision in the treatment of locally resectable rectal cancer： a systematic review

目的评价术前放疗联合全直肠系膜切除术（TME）治疗局部可切除直肠癌的临床疗效。方法全面检索1982年1月至2009年4月间发表的评价术前放疗的前瞻性临床随机对照试验研究，按纳入和排除标准筛选，提取人选试验的基本特征和临床疗效数据。对研究目的相同的多项随机对照试验的临床数据采用RevMan4．2软件进行定量合并．对不符合定量合并要求的数据作统计描述。结果符合选择标准的临床随机对照试验9项。短程术前放疗联合规范的TME手术组治疗直肠癌的2年局部复发率为2．4％，低于单纯TME手术组的8．2％（P〈0．01）。术前放疗患者的4年总生存率和无病生存率与术前常规分割放化疗患者相比，差异无统计学意义（P〉0．05）：两组患者的局部复发率差异也无统计学意义（RR=1．16，95％C10．37～3．61，P=0．80）。术前高剂量放疗组完全缓解率显著高于低剂量组（16．0％比2．0％，P〈0．05）．保肛手术率提高3．9％。结论TME术前放疗可降低直肠癌术后局部复发的风险。

Objective To assess the clinical efficacy of preoperative radiotherapy combined with total mesorectal excision （TME） in the treatment of locally resectable rectal cancer. Methods Literature search was carried out to identify prospective clinical randomized controlled trails on preoperative radiotherapy for rectal cancer published from January 1982 to April 2009. The basic characteristics and clinical efficacy of the trials meeting the screening criteria were enrolled. Date analysis was performed by RevMan 4.2. Results According to the selection criteria, 9 clinical trials were included. Compared with surgery alone, the short-term preoperative radiotherapy was associated with reduced 2- year local recurrence rate （2.4% vs 8.2%, P〈0.01）. There were no significant differences in 4-year overall survival（67.2% vs 66.2%）, 4-year disease-free survival （58.4% vs 55.6%） and local recurrence （RR = 1.16, 95% CI： 0.37-3.61, P=0.80） between the preoperative radiotherapy and radiochemotherapy. High-dose preoperative radiotherapy could increase the complete response rate and sphincter sparing surgery rate than that low-dose （16.0% vs 2.0%, P〈0.05）. The interval between preoperative radiotherapy and operation did not affect the overall survival, disease-free survival and local recurrence. Conclusion Preoperative radiotherapy combined with total mesorectal excision is associated with lower local recurrence.