- 期刊
Patterns of Pelvic Recurrence and Results of Salvage Treatment with Radiation Therapy for Recurrent Rectal Carcinoma
直腸癌手術後的復發型態及放射線挽救性治療的結果
摘要
爲了對直腸癌手術後復發的型態及使用放射綫來作挽救性治療的效果及病患存活情形有所瞭解，本文回顧性分析了56個自1987年11月至1991年12月治療的病例。復發的症狀或表徵以尾椎底部疼痛最常見(66%)，其次則是尿路阻塞(45%)。原始分期以B3、C3最多，兩者合計占64%。復發的時問以手術後第一年最多占70% , 96%的復發發生在手術後的前三年，只有4%的復發是手術後3年發生。42%的病例在復發時有CEA值的升高。腫瘤經放射治療後，在38例可評估病人中，4例(11%)達完全消失，18例(47%)腫瘤縮小超過一半，10例(26%)腫瘤縮小未達一半，6例(16%)腫瘤沒有反應。局部疼痛改善方面，在31例單獨放射治療且以局部疼痛表現者，10例(32%)自覺有良好改善，14例(45%)自覺有改善但疼痛仍存在，7例(23%)自覺沒有改善。整體存活率為2年19%,3年7%，先行手術再放射治療和單獨使用放射治療兩者存活率幷沒有統計上的差別(12%與5%)，有鑑於直腸癌手術後復發的不良預後，治療的目標應著手於局部復發的預防治療。
並列摘要
Patterns of pelvic recurrence and results of salvage with radiation therapy in 56 patients with postsurgical recurrent rectal carcinoma treated between November 1987 and December 1991 were retrospectively analyzed. The common presenting symptoms/signs were sacral pain (66%), following by obstructive uropathy (45%). In modified Astler-Coller classification, stage B3 and C3 are the most common initial stage of the patients, comprising 64% of cases. Presacral area was the most common site of recurrence (30%). 70% of patients recurred at the first year of surgery. Cumulative rate of recurrence at 3 years was 96%. Only 4% of patients recurred beyond 3 years after surgery. 42% of cases had CEA elevation at the time of recurrence. There were 38 patients evaluable for tumor response to radiation therapy alone. Of them, 4 cases (11%) achieved complete tumor regression, 18 cases (47%) had partial tumor regression, 10 cases (26%) had tumor regression less than 50%, and 6 cases (16%) had no objective tumor regression. In 31 ItT-alone patients with sacral pain, 10 cases (32%) achieved good pain relief, 14 cases (45%) achieved moderate pain relief, and 7 cases (23%) had no pain relief at all. Overall survival in 56 patients was 19% at 2years, and 7% at 3 years. No statistically significant difference of survival existed between surgery plus radiation therapy and radiation-alone group. In viewing the grave outcome of recurrent patients, treatment strategy must be aimed at prevention of local recurrence for high risk group of patients.
延伸閱讀
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