直腸癌的放射線與手術之配合治療

Combined Radiotherapy and Surgery for Rectal Cancer

梁基安(Ji-An Liang) ； 林芳仁(Fang-Jen Lin) ； 陳明憲(Ming-Shen Chen) ； 湯國政(Simon G. Tang)

《中華放射線醫學雜誌》 17卷3期 (1992/09) Pp. 223-231

摘要

A series of 330 patients with rectal and rectosigmoid cancer were treated with ”curative therapy” of radiotherapy and surgery from Nov. 1979 to Dec. 1987 at Chang Gung Memorial Hospital. There were 211 males and 119 females at the age of 18 to 81 years. The preoperative irradiation dose was 2000 cGy and the total dose of postoperative radiotherapy was 5600 cGy to 6000 cGy. The period of follow-up was from 30 to 127 months. All patients were classified according to modified Astler-Coller staging and histological differentiation. The actuarial 5-year survival rates were 100%, 100%, 66%, 14%, 85%, 36% and 27% for stages A, B1, B2, B3, C1, C2 and C3 respectively. Patients with more advanced lesions had worse prognosis. The patients with well-differentiated (W-D) histological grading had better 5-year survival rate than the patients with poorly-differentiated one (85% vs 33%, p＜0.001). Local recurrence usually occurred at presacral (13 cases) and perineal regions (14 cases). Lung and liver were the most common organs of distal metastasis. Intestinal obstruction was a major complication of combined radiotherapy and surgery, but it can be minimized by improved skill and techniques. To evaluate different modalities, the patients who received postoperative irradiation only had better five-year survival rate than those who received combined preoperative and postoperative irradiation, especially for the group with stage B2. It is also noted for the lower local recurrent and distant metastatic rates, but not significant.

關鍵字

直腸腫瘤 ； 手術前放射治療學 ； 手術後放射治療學

並列摘要

A series of 330 patients with rectal and rectosigmoid cancer were treated with ”curative therapy” of radiotherapy and surgery from Nov. 1979 to Dec. 1987 at Chang Gung Memorial Hospital. There were 211 males and 119 females at the age of 18 to 81 years. The preoperative irradiation dose was 2000 cGy and the total dose of postoperative radiotherapy was 5600 cGy to 6000 cGy. The period of follow-up was from 30 to 127 months. All patients were classified according to modified Astler-Coller staging and histological differentiation. The actuarial 5-year survival rates were 100%, 100%, 66%, 14%, 85%, 36% and 27% for stages A, B1, B2, B3, C1, C2 and C3 respectively. Patients with more advanced lesions had worse prognosis. The patients with well-differentiated (W-D) histological grading had better 5-year survival rate than the patients with poorly-differentiated one (85% vs 33%, p＜0.001). Local recurrence usually occurred at presacral (13 cases) and perineal regions (14 cases). Lung and liver were the most common organs of distal metastasis. Intestinal obstruction was a major complication of combined radiotherapy and surgery, but it can be minimized by improved skill and techniques. To evaluate different modalities, the patients who received postoperative irradiation only had better five-year survival rate than those who received combined preoperative and postoperative irradiation, especially for the group with stage B2. It is also noted for the lower local recurrent and distant metastatic rates, but not significant.

並列關鍵字

Rectum ； neoplasm ； therapeutic radiology ； preoperative ； therapeutic radiology ； postoperative