Preoperative Radiotherapy in Patients with Lower Rectal Cancer: Results of Sphincter-Preservation, Treatment Outcome and Morbidities

直腸癌之術前放射治療：器官保留，治療結果，及後遺症

葉世安(Shyh-An Yeh) ； 陳鴻華(Hong-Hwa Chen) ； 王重榮(Chong-Jong Wang) ； 林聰敏(Tsung-Min Lin) ； 黃英彥(Eng-Yen Huang) ； 熊敬業(Ching-Yeh Hsiung)

《放射治療與腫瘤學》 5卷4期 (1998/12) Pp. 245-252

https://doi.org/10.6316/TRO/199805(4)245

摘要

目的：研究術前放射治療應用於低位直腸癌患者，在促進器官保留之角色，並評估其治療結果及後遺症。
材料和方法：從1992年4月至1996年12月，共有43位直腸癌患者因腫瘤位置過於接近肛門，經外科醫師判斷無法同時切除腫瘤並保留肛門，為了提高病患接受腫瘤切除並保留肛門之機會，於本科接受術前放射治療。照射範圍為骨盆腔，劑量為37.5 Gy，計15次，每週治療五天。
結果：放射治療後有30位(70%)患者可接受保存肛門之低前位切除術。三年整體存活率、無病存活率、局部控制率各為60%、62%、及89%。單變數分析發現病理分期及局部淋巴結轉移對於整體存活率及無病存活率為有意義之預後因子。對於局部控制率則只有局部淋巴結轉移為有意義之預後因子。接受保存肛門之低前位切除術並不影響患者之存活率及局部控制率。以多變數分析發現病理分期為影響無病存活率之獨立因子，而局部淋巴結轉移為影響局部控制率之獨立因子。
結論：術前放射治療應用於低位直腸癌患者，可使病患有相當機會接受保留肛門之切除術。同時，經由術前放射治療而保存之肛門，其括約肌功能在大部份病人皆為正常。如何改進治療技術，以減少放射治療之副作用，仍有待努力。

關鍵字

術前放射治療 ； 器官保留 ； 直腸癌 ； 後遺症

並列摘要

Purpose: To study the impact of preoperative irradiation on enhancing sphincter preservation and to evaluate the treatment outcome in patients with lower rectal cancer. The results were analyzed for the endpoints of sphincter preservation, sphincter function, pelvic control, disease-free survival, overall survival and treatment-related morbidities.
Materials and Methods: From 1992 to 1996, 43 patients with clinically resectable rectal cancer received preoperative radiotherapy at our department. All of these patients had undergone a prospective clinical assessment by their surgeons and were declared to require an abdominoperineal resection due to the proximity of the tumor to the anal sphincter. The whole pelvis received 37.5 Gy in daily fraction of 2.5 Gy with parallel opposed anterior-posterior portals.
Results: Thirty of the forty-three patients (70%) were able to undergo low anterior resection. The majority (88%) of patients had good sphincter function after sphincter-preserving surgery. The pathologic stage was T2 in 11 patients and T3 in 32 patients. The 3- year overall survival rate, disease-tree survival rate, and local control rate of the 43 patients were 60%, 62%, and 89%, respectively. In univariate analysis, pathologic stage and the presence of regional lymphadenopathy were noted as significant prognostic factors for both overall survival and disease-free survival. With regard to local control, only the presence of regional lymphadenopathy showed prognostic significance for local control. No difference in survival rate and local control rate was observed between patients undergoing low anterior resection and those undergoing abdominoperineal resection. In multivariate analysis, pathologic stage was noted as the only independent prognostic factor for disease-free survival; likewise, only the presence of lymphadenopathy was demonstrated as an independent predictor for local control. No clinical and pathologic parameters were proved to be independent prognostic factors for overall survival. Acute intestinal toxicity included grade 1 in 10 (23%) patients, grade 2 in 18 (42%) patients, and grade 3 in 2 patients (5%). No patients had acute urological toxicity.
Conclusion: With the help of preoperative radiotherapy, a significant proportion of patients would have a chance to receive sphincter-preserving surgery. Furthermore, the preserved sphincter functioned well in most of the patients. Further efforts should be made to reduce the treatment-related morbidities.

並列關鍵字

Preoporative radiotherapy ； Sphincter preservation ； Rectal cancer ； Morbidity