三维适形放射治疗直肠癌术后复发的临床观察

近年来三维适形放射治疗 ( 3DCRT)已广泛应用于临床多部位的肿瘤治疗 ,但至今国内尚未见用该技术治疗直肠癌术后局部区域复发的相关报道。笔者回顾性分析 2 0 0 0年 5月至 2 0 0 3年 5月利用 3DCRT治疗直肠癌术后局部复发病例17例 ,旨在探讨其临床意义。一、材料与方法1.临床资料 :17例直肠癌术后局部复发病例中 ,男 11例 ,女 6例 ,中位年龄 5 8岁。临床Dukes分期B期 6例 ,C期11例。卡氏评分≥ 70。病理分类中腺癌 11例 ,黏液腺癌 4例 ,印戒细胞癌 2例。术后复发时间 8～ 17个月 ,中位值 11个月。全组病例临床表现均有会阴区或骶尾区持…     

结直肠癌术后局部复发或转移的三维适形放疗

目的评价三维适形放疗对术后局部复发或转移的结直肠癌患者局部控制率和生存率的影响。方法23例术后局部复发或转移的结直肠癌患者采用三维适形放疗，5—7Gy／次，隔日1次，共6—8次，总剂量0140—45Gy。结果完全缓解率为35％(8／23)，部分缓解率为39％(9／23)，有效率为74％(17／23)。1、2、3年生存率分别为78％、52％、30％。结论三维适形放疗可提高术后局部复发或转移结直肠癌的控制率和生存率，改善其生存质量。     

食管癌术后局部复发三维适形全程加速超分割放疗的疗效观察

食管癌根治性切除术后大约4JD%以上出现局部复发,是治疗失败的主要原因。黄国俊等报道术后2年死亡病例中复发和(或)转移占77.4%。即使是术后超过15年的患者仍有27.3%死于局部复发。对术后局部复发的治     

三维适形放疗联合同步化疗治疗直肠癌术后复发

[目的]探讨三维适形放疗同步化疗治疗直肠癌术后复发的疗效。[方法]78例术后复发直肠癌患者分为适形放疗加化疗组(适形组)39例,常规放疗加化疗组(常规组)39例。观察并比较两组的临床疗效和不良反应的发生。[结果]适形组和常规组1、2、3年生存率分别为89.7%、64.1%、46.2%和64.1%、35.9%、23.1%(P<0.05),中位生存期分别为35个月和20个月;3年肿瘤局部控制率分别为64.1%、41.0%(P<0.05);适形组放射性直肠炎、放射性膀胱炎和皮肤反应的发生率低于常规组(P<0.05)。[结论]三维适形放射治疗联合FOLFOX方案同步化疗是治疗直肠癌术后复发的安全有效的方法,能明显地提高患者的远期生存率,减少放疗反应。     

放疗联合替吉奥化疗治疗术后复发直肠癌的临床观察

目的 探讨替吉奥胶囊化疗同步三维适形放疗(3DCRT)治疗术后复发直肠癌(RCC)的临床疗效及安全性.方法 将60例复发直肠癌患者根据治疗方法的不同分为对照组和研究组,每组30例.2组都采用三维适形放疗治疗,研究组采用三维适形放疗同步替吉奥治疗.比较2组患者的临床疗效及不良反应发生率.结果 研究组有效率为73.33％,明显高于对照组的40.00％(x2=6.79,P＜0.05).研究组的中位无病进展时间(PFS)为11.2个月,显著高于对照组的8.7个月(P＜0.05).研究组大体肿瘤体积(GTV)、计划靶区(PTV)、V20、小肠V20、心脏V40、放疗体积明显小于对照组(P＜0.05);2组脊柱体积无明显差异(P＞0.05).研究组和对照组Ⅲ、Ⅳ度中性粒细胞下降率分别为20.0％、3.3％,恶心呕吐率分别为30.0％、6.6％,腹泻率分别为23.3％、3.3％,研究组均显著高于对照组(P＜0.05).结论 三维适形放疗同步替吉奥化疗治疗直肠癌术后复发的疗效确切,但其Ⅲ/Ⅳ级血液学毒性及胃肠道反应发生率高于单纯应用三维适形放疗.     

三维适形放疗宫颈癌盆壁复发的临床观察

 目的： 评价立体定向适形放疗治疗宫颈癌盆壁复发的疗效及不良反应。方法：选取宫颈癌治疗后盆壁复发患者21例，以直线加速器6MV-X线行立体定向适形放疗，单次剂量5-8.5Gy，隔日1次，总剂量30-52Gy，平均剂量40.32 Gy。疗后1.5个月及3个月时行CT复查。结果：腰腿疼痛缓解率达100%，患侧下肢水肿缓解率61%，治疗肿瘤有效率(CR+PR)为71.4%（15/21），1、2、3年生存率分别为38%、14%、4%，中位生存时间16个月。结论：立体定向适形放疗能有效的控制宫颈癌盆壁复发肿瘤，较常规放、化疗疗效提高，没有增加消化系、泌尿系的放疗反应。     

三维适形放疗治疗宫颈复发癌的临床观察

目的：探讨三维适形放疗（３ＤＣＲＴ）治疗宫颈复发癌的疗效和毒性反应。方法：２００３年１０月～２００６年１１月共收治宫颈复发癌３４例,采用３ＤＣＲＴ,总剂量５０～６５Ｇｙ。结果：所有患者均完成３ＤＣＲＴ治疗。获完全缓解（ＣＲ）为２４.２％（８／３３）,部分缓解（ＰＲ）为４５.４％（１５／３３）,有效率（ＲＲ）为６９.６％;疼痛缓解率为９２.６％（３１／４１）,出血完全缓解率为９０.９％（１０／１１）,生活质量明显改善,无治疗相关性死亡。中位生存期（ＯＳ）１９.８个月;１、２、３年生存率分别为５１.５％、２４.２％和１８.２％。结论：采用３ＤＣＲＴ治疗宫颈复发癌的疗效较好,可以提高局部控制率和延长生存期,并能提高生活质量,毒副反应亦可耐受。     

直肠癌术后复发的治疗

几组回顾性调查结果表明 ,直肠癌手术后整体复发率超过 40 % ,即使最好的治疗中心其复发率也达 2 5 % ;其中Ｔ3～4Ｎ1～ 2Ｍ0的患者 ,疗后复发率可达 45 %～ 65 % [1 ] 。局部复发致死约占 5年死亡率的一半 ,另一半死于远地转移。即使使用有效的联合治疗 ,如术前、术后化疗加放射治疗 ,局部复发率仍有 1 0 %～ 1 5 %。直肠癌复发治疗困难 ,预后差 ,是广大临床工作者面临的棘手问题。现将直肠癌术后复发的治疗方法综述如下。一、手术治疗直肠癌术后复发如发生在吻合口 ,再次手术效果好。但这种预后好的患者仅占复发病例的 30 %以下 ,而 70 %…     

同步三维适形放化疗治疗直肠癌术后复发的疗效观察

目的观察直肠癌术后复发病例三维适形放射治疗同步化疗的疗效。方法回顾性分析58例直肠癌术后复发患者接受同步三维适形放疗化疗的疗效,放疗总剂量在60Gy-68Gy,并于放疗同时给予5-Fu/LV”方案(LV400mg/m2,d1-5,5-Fu400mg/m2,d1-5,持续滴注22h)化疗二周期。结果按WHO制订标准,患者1、2、3年肿瘤局部控制率分别为87.6%、66.7%、38.6%;1、2、3年生存率分别为88.7%、67.8%、42.5%,中位生存期25.6个月;急性放射反应主要是急性放射性肠炎,多为1-2级,无晚期放射反应发生。结论同步三维适形放射治疗、化疗治疗复发性直肠癌取得较好疗效,毒副反应可耐受。     

后程三维适形放射治疗配合化疗治疗直肠癌术后复发临床观察

目的探讨后程三维适形放射治疗结合化疗治疗直肠癌术后复发的疗效。方法49例术后复发直肠癌随机分为适形放疗加化疗组(适形组)25例,常规放疗加化疗组(常规组)24例。适形组前程采用6MV X线全盆腔放疗46Gy后改作三维适形放射治疗推量至70Gy,常规组采用6MV X线全盆腔放疗46Gy;后采用两后斜野成角照射推量至66Gy,两组均于放疗第一周及最后一周化疗,予5-氟尿嘧啶500mg/m2,甲酰四氢叶酸钙200mg,d1~5,静脉滴注。生存分析采用Kaplan-Meier法。结果适形组和常规组1、2、3年生存率分别为88.0%、64.0%、48.0%和66.7%、45.8%、37.5%(P=0.08),中位生存期分别为35和22月;3年肿瘤局部控制率分别为68.0%、41.7%(P<0.05),毒副反应两组差异无统计学意义。结论三维适形放射治疗结合化疗是治疗直肠癌术后复发的有效治疗方法,能明显地提高患者的近期生存率。     

Development of an irradiation method of intraoperative radiation therapy for curatively resected rectal cancer

Background. Intraoperative radiation therapy (IORT) has been performed to prevent local recurrence of rectal cancer only when positive margins are suspected. To further reduce local recurrence, we attempted to develop a new IORT irradiation method in which electron beam irradiation is administered as uniformly as possible to the intrapelvic dissection surfaces. Methods. Low anterior resection and abdominoperineal resection were performed in one male and one female cadaver. Electron beam irradiation was administered by four different methods, and absorbed doses were measured at 15 sites within the pelvis. We also attempted to measure absorbed doses at nine sites within the pelvis in 14 patients treated with IORT. Results. The cadaver study revealed low absorbed doses in the lateral walls of the pelvis when a single irradiation was delivered from the anterior. When the lateral walls of the pelvis were irradiated twice, once each time on the right and left, the absorbed doses were low in the central pelvis and presacrum. Relatively high absorbed doses were achieved in all of these areas by a technique that combined these two methods. Adequate absorbed doses were not achieved by a single irradiation administered from the perineum. Conclusion. This study suggests that electron beam irradiation administered three times to the dissected surfaces in the pelvis after resection of rectal cancer (i.e., to the central pelvis and presacrum from the anterior, and to the left and right lateral walls of the pelvis) is the most suitable method for achieving adequate absorbed doses. Received: May 6, 1998 / Accepted: December 15, 1998     

Site-specific risk factors for local recurrence after rectal cancer surgery

BackgroundQuite few studies examined risk factors for local recurrence after rectal cancer surgery with respect to local recurrence sites.MethodsLocal recurrence sites were categorized into axial, anterior, posterior, and lateral (pelvic sidewall), and axial, anterior, and posterior type were combined as the “other” type of local recurrence. Among 76 patients enrolled into our prospective randomized controlled trial to determine the indication for pelvic autonomic nerve preservation (PANP) in patients with advanced lower rectal cancer (UMIN000021353), multivariate analyses were conducted to elucidate risk factors for either lateral or the “other” type of local recurrence.ResultsUnivariate analyses showed that tumor distance from the anal verge was significantly (p = 0.017), and type of operation (sphincter preserving operation (SPO) vs. abdominoperineal resection (APR)) was marginally (p = 0.065) associated with pelvic sidewall recurrence. Multivariate analysis using these two parameters showed that tumor distance from the anal verge was significantly and independently correlated with pelvic sidewall recurrence (p = 0.017). As for the “other” type of local recurrence, univariate analyses showed that depth of tumor invasion (p = 0.011), radial margin status (p < 0.001), and adjuvant chemotherapy (p = 0.037) were significantly associated, and multivariate analysis using these three parameters revealed that depth of tumor invasion (p = 0.004) and radial margin status (p < 0.001) were significantly and independently correlated with the “other” type of local recurrence.ConclusionRisk factors for local recurrence after rectal cancer surgery were totally different with respect to the intra-pelvic recurrent sites. Site-specific probability of local recurrence can be inferred using these risk factors.Trial registration numberUMIN000021353.     

直肠癌术后局部复发的治疗与预后分析

目的 分析直肠癌根治术后局部复发患者的生存状况及影响因素.方法 回顾性分析四川省肿瘤医院2013年10月至2018年1月收治的35例单纯性直肠癌局部复发患者的资料,分析其生存状况,并采用多因素Cox回归分析影响预后的相关因素.结果 35例患者中男20例,女16例;中位生存期125(6～144)个月,5年存活率为53.1...     

Early local recurrence and one-year mortality of rectal cancer after restricting the neoadjuvant therapy regime

IntroductionTo reduce the risk of local recurrence after rectal cancer surgery, neoadjuvant radiotherapy (RT) can be applied. However, as this causes morbidity and increases mortality, new Dutch guidelines withhold RT in low-risk patients. The aim of this study is to investigate if early local recurrence and one-year mortality in rectal cancer patients has changed since this more restricting indication for neoadjuvant RT was introduced in 2014.MethodsThis retrospective study included all consecutive patients treated with a mesorectal excision for primary rectal cancer in the Amphia Hospital, the Netherlands, between January 2011 and July 2016. Data were extracted from the electronic patient records. Survival data were collected from the Municipal Personal Records Database.ResultsBetween 2011 and July 2016, 407 resections of primary rectal cancer without synchronic metastases were performed, 225 under the old guidelines and 182 under the new guidelines. Significantly fewer patients received neoadjuvant treatment under the new guidelines (89% vs 41%, p < 0.001). Both clinical tumour stage (p = 0.001) and clinical lymph node stage (p < 0.001) were lower in the new group, but no difference in pathologic TN-stage was found. There was no difference in one-year local recurrence (2.2% in both groups, p = 0.987), nor in one-year mortality (5.3% vs 3.8%, p = 0.479).ConclusionIntroducing a new guideline and thereby restricting the indication for neoadjuvant RT in rectal cancer patients did not increase the early local recurrence rate or decreased one-year mortality in our hospital.     

Successful rectal cancer local recurrence radiofrequency ablation

Local rectal cancer recurrences represent a great challenge, as surgical re-excisions or re-irradiation procedures are not always feasible. Moreover, scar or local recurrence is hard to elucidate with conventional diagnosis techniques. Emerging diagnostic and therapeutic procedures may be useful in this setting. A local rectal cancer recurrence radiofrequency ablation is reported. PET scan confirmed the recurrence, defined the target volume and assessed the success of the local therapy.     

Intra-operative radiotherapy of rectal cancer: Results of the French multi-institutional randomized study

Purpose

To assess efficacy and tolerance of intra-operative radiation therapy (IORT) in patients suffering from locally advanced rectal cancer, treated with preoperative radiotherapy followed by surgical resection.

Methods and materials

In this French, multicenter, comparative, phase III study, 142 patients with locally advanced rectal cancer (T3 or T4 or N+, and M0), treated with a 4-week preoperative radiotherapy (40 grays) were randomly assigned to either surgical resection alone (Control group: n = 69) or combined to 18-gray intra-operative radiation therapy (IORT group: n = 73) between 1993 and 2001.

Results

The 5-year cumulative incidence of local control was 91.8% with IORT and 92.8% with surgery alone (p = 0.6018); the mean duration without local relapse (Kaplan-Meier method) was 107 versus 126 months, respectively. No statistically significant difference was demonstrated for overall survival (p = 0.2578) disease-free survival (p = 0.7808) and probability of metastatic relapse (p = 0.6037) with 5-year cumulative incidences of 69.8% versus 74.8%, 63.7% versus 63.1%, and 26.1% versus 30.2%, respectively. 48 patients of the IORT group and 53 patients of the control group were alive with a median follow-up of 60.1 and 61.2 months, respectively. Post-operative complications were observed in the IORT group in 21 patients (29.6%) and in the control group in 13 patients (19.1%) (p = 0.15), with an acceptable tolerance profile.

Conclusions

Although this randomized study did not demonstrate any significant improvement in local control and disease-free survival in rectal cancer patients treated with preoperative radiation therapy receiving IORT or not, it confirmed the technical feasibility and the necessity for evaluating IORT for rectal carcinoma in further clinical studies.     

Adjuvant radiation therapy for rectal cancer

Since 1976, 104 patients with rectal cancer have been treated with a new approach of combined pre- and postoperative radiation. All patients were given 500 rad preoperative irradiation on the day of or the day before surgery. Surgery in the majority of patients was an abdominal perineal resection. The disease was then staged pathologically according to Astler-Coller's modification of Duke's staging. Patients with early stage cancer (Stages A and B1) were followed with no further therapy. Patients with poor prognostic characteristics (Stages B2, C1, C2) were given postoperative pelvic irradiation (4500 rad in 5 weeks). Twenty-nine patients were found to have Stage A or B1 cancer and were followed with no further therapy. Of these 29 patients, 1 patient developed recurrence and one has died of metastatic disease. The excellent survival of patients with early tumors indicates that minimizing the role of adjuvant therapy in this group has not been detrimental to their survival. Fifteen were found to have liver metastases at laparotomy and had just a colostomy and palliative therapy. Sixty patients had Stage B2 and C disease. Thirty-one received postoperative irradiation as per protocol. Twenty-nine patients did not receive postoperative irradiation for a variety of reasons. Follow-up ranges from 1 to 7 years in these patients. Of the 29 patients with Stage B2 and C disease who should have but did not receive postoperative radiation, 10 patients (34%) have developed a recurrence in the pelvis, and 5 other patients (17%) have developed metastatic disease. Of 31 patients who received postoperative irradiation, only 2 patients (6%) developed a local recurrence and 4 patients (13%) have developed distant metastases. Survival at 3 years was 80% for patients receiving the combined treatment, as compared to 42% for those not receiving the postoperative part of the treatment protocol.     

直肠癌的三维适形放疗及多肿瘤标志物的变化

目的：探讨局部晚期和术后复发性直肠癌三维适形放射治疗（3D-CR）的临床疗效及多肿瘤标志物的变化.方法：60例局部晚期和术后复发性直肠癌均在外照射40Gv后随机分为后程适形放疗组（适形组）30例,常规放疗组（对照组）30例.适形组放疗前后及再次复发后查多肿瘤标志物.结果：适形组及对照组有效率分别为86.7%和70.0%,两组差异无显著性意义（P＞0.05）.适形组及对照组1、2、3年生存率分别为80.0%,53.3%,36.7%;56.7%,40.0%,13.3%,P=0.021 3;两组差异有显著性意义.适形组CEA、CA19-9、CA242、FER在放疗后较放疗前降低,P＜0.01,有显著性意义.再次复发后较未复发时升高,P＜0.01,有显著性意义.结论：局部晚期和术后复发性直肠癌常规外照射加三维适形放疗有较好疗效.多肿瘤标志物蛋白质芯片诊断系统可作为疗效及预后判断的一项有效指标.