直肠癌手术前后辅助放疗疗效比较

Pre-and Post-operative Radiotherapy for Rectal Cancer

［目的］探讨比较术前单次、术前４０Ｇｙ放疗及术后放疗对直肠癌疗效的影响。〔方法）１２７例病理证实的直肠癌患者， 于１９９０年 ４月至 １９９４年 １２月随机分为 ３组，分别为术前单次组 ３９例，术前４０Ｇｙ组 ４３例和术后放疗组 ４５例。术前放疗组中病理 若属Ｔ_３期以上，则加用术后放疗。术前单次组放疗剂量为５Ｇｙ－６Ｇｙ／次，放疗后４８ 小时内手术。术前４０Ｇｙ组中位剂量为４０Ｇｙ／２０ 次（２０Ｇｙ－ ４０Ｇｙ），放疗后休息 ４周手术。术后放疗组中位剂量为 ５５．１Ｇ ｙ／２９次（３０Ｇｙ－ ６３Ｇｙ／１５次～ ３５次），手术放疗间隔为 ３～ ４ 周。［结果］全部病例中位随访７８个月，３组中位生存期分别为５５、５８、４７个月，Ｋａｐｌａｎ Ｍｅｉｅｒ法计算３年及５年生存率分别为 ７４．３％、４８７％，６７．４％、４８９％和６２２％、４２２％。局部复发率分别为１２．８％、２３．１％，１４．０％、２３．３％和２２．２％、２８．９％。单因素Ｌｏｇ ｒａｎｋ检验术前放疗２组３年局部复发率低于术后放疗（Ｐ＜０．０５）。５年局部复发率和生存率无差别。［结论］适当剂量的术前放 疗较术后放疗具有更高的局控率和较低的副反应。

[Purpose]To evaluate and compare the efficacy of adjuvant pre -- and post -- operative radiotherapy for rectal cancer[Methods] Between Apr.1990 to Dec. 1994, 127 patients with rectal cancer histologically proved were randomized to 3 pops: (1 )39 patients treated with single fraction preoperative radiotherapy, with a tumor dose of 5Gy ~ 6Gy; operation was performed within 48 home. (2)43 patients treated with 40Gy conventional preoprative radiotherapy, with a median tumor dose of 40Gy/20fr(20Gy ~ 42Gy/10fr ~ 21f r), operation was performed 4 weeks following radiotherapy; (3) 45 patients underwent post -- operative radiotherapy with a median tumor dose of 55. 1Gy/29fr(30Gy ~ 63Gy/15fr ~ 35f r), 3 ~ 4 weeks. [ Result] The median survival was 55,58 and 47 months respectively. The 3 -- and 5 -- years following operation survival rates were: 74.3%, 48.7% in Group 1, 67.4%,48.9% in Group 2 and 62.2%,42.2% in Group 3; Local recurrent rates were: 12. 8%,23. l% in Group 1 14.0%,23.3% in Group 2 and 22. 2%, 28. 9% in Group 3. Only the 3-year local recurrent rates for preoperative radiotherapy group were significantly lower than that for postoperative radiotherapy group(P < 0. 05). [ Conclusion] Proprative radiotherapy for rectal cancer with proper dose is more effective in local control and less complications than postoperative radiotherapy