直肠癌术前野中野放疗的随机前瞻性研究

A prospective randomized study of the effect of field - in - field preoperative radiotherapy in operable rectal carcinoma

目的探讨和评价本技术在直肠癌治疗中的地位及其疗效。材料与方法１９９０年２月至１９９３年１０月，４９例临床可切除的直肠腺癌被随机分为两个研究组：２４例进入单纯手术治疗组（手术组），另２５例随机进入术前放疗组（放疗组）。术前放射治疗剂量为４４Ｇｙ／４～５周，同时采用野中野间插照射４次（每次１Ｇｙ，每周２次）。放疗后４～６周接受外科手术。结果入组和可评价的４６例（９３．９％）随访时间至少２４个月，平均４２个月。两组生存率或手术并发症无统计学差异，但局部复发率放疗组（１２％）明显的低于手术组（４０．９％）。放疗组中有４例术后标本病理检查未发现癌。结论野中野放疗技术通过提高局部剂量能改进肿瘤的局部控制率，作为术前放疗技术可能在直肠癌治疗中具有重要价值。

Purpose A randomized trial was performed for patients with rectal cancers by using a technique of field - in - field preoperative irradiation to evaluate the role of preoperative radiotherapy Materials and Methods Between February 1990 and October 1993, 49 cases of clinical resectable rectal adenocarcinoma were randomized into two groups 24 entered in surgery treatment alone ( op - group) , and 25 , in preoperative irradiation group (Rt - group) with 44Gy in 4-5weeks. A concomitant boost dose of 4 Gy divided into 4 fractionations was delivered by using a field - in - field irradiation technique, and operation was performed in 4 - 6 weeks after radiotherapy. Results 46 ( 93 . 9 % ) eligible and evaluable patients were followed up for at least 24 months with a median of 42 months, there is no significant difference of survivals (62 . 4 % for Rt - group and 58.1% for op-group ) or operation complication(48%. and 41.7%) between the two groups. However, three patietnts (12% ) in Rt - group and 10 patietnts (40. 9% ) in op - group had local recurrence. In Rt-group,no tumor was seen in 4 cases (15%) pathologically Conclusion The technique of field-in- field preoperative radiotherapy can improve local control rate due to increasing local doses, and can play an important role in the management of rectal carcinoma