直腸癌手術前進行放射線治療有正面效益


  May 2, 2005 (費城) - 美國大腸直腸外科醫學會年會中有一項發表,根據一追蹤資料顯示,在進行直腸癌治療手術前,先給予短期的放射線治療,效果可以維持10年;這些效益包含了整體的復原進展,較低的特定癌症存活率及局部性癌細胞復發率。
  
  追蹤資料來自瑞典直腸癌臨床試驗機構(Swedish Rectal Cancer Trial),一共有1168位患者,在1987至1990年間,以隨機分配的方式在手術前一週接受放射線治療,劑量為25Gy(5x5),或只接受單一手術;其中,908位在後來接受了一項R0的切除手術,這項手術亦被視為治療之一;本次研究所用的資料,平均追蹤期為13年。
  
  術前接受放射治療的患者,整體存活率為38%,單一手術組則為30%;試驗組中,特定癌症的患者存活率為72%,單一手術組則為62%。
  
  主研究員,來自瑞典Uppsala大學附設醫院的Joakim Folkesson醫師表示,整體的局部復發率,試驗組為9%,單一手術組為26%;復發率的降低,顯見於所有的腫瘤期(I-III)及距肛門邊緣達10公分的腫瘤;對於所有的患者而言,5年以後的復發率都很低。
  
  目前的研究並未對嚴重毒性的潛力,及是否會對腸內功能產生負面影響作強調,這些現象都有可能伴隨高劑量的放射線治療而來;Folkesson醫師指出,他的研究團隊已經蒐集了長期的發病資料,只是尚未公佈出版。
  
  Folkesson醫師表示,在手術8年後,我們看到了一些因為腹部問題而再度就診的案例,因為這類問題而產生的患者抱怨,有著增加的情形;在短期內,唯一的差異就是肛門邊緣外傷的痊癒速度;多年後,放射線治療組的患者,二度癌症的案例或許也會有增加的現象。
  
  Folkesson指出,放射線治療的效果早已為人所知,我們現在只是將適用的患者篩選出來;可能無法獲得同等效益的患者,含早期腫瘤者,或腫瘤距肛門緣雖超過10公分,卻因良好的手術而獲得腫瘤清除者。
  
  ASCRS 2005年會:摘要S4,May 2, 2005提出。

Radiation Before Rectal Cancer

By
Medscape Medical News

Jennifer Reid Holman

May 2, 2005 (Philadelphia) — The benefits of receiving short-term radiation prior to curative rectal cancer surgery remain after more than 10 years, according to follow-up data presented here at the American Society of Colon and Rectal Surgeons annual meeting. These benefits include an improvement in overall and cancer-specific survival as well as a lower incidence of local recurrence of the cancer.

The data come from the ongoing Swedish Rectal Cancer Trial, which included 1,168 patients randomized between 1987 and 1990 to groups receiving either 25 (5 x 5) Gy radiotherapy a week before surgery or surgery alone. Of these patients, 908 patients later underwent an R0 resection and were considered curatively treated. The median follow-up time for the current round of data was 13 years.

Overall survival in patients who received preoperative radiotherapy was 38% compared with 30% for patients receiving only surgery. Cancer-specific survival rates were 72% in the preoperative radiotherapy group vs 62% in the surgery-only group.

Overall local recurrence rates were 9% in the radiation group and 26% in the surgery-only group. The reduction in recurrence was significant for all tumor stages (I-III) and for tumors positioned up to 10 cm from the anal verge. Very few recurrences among all patients occurred after five years, said lead investigator Joakim Folkesson, MD, from Uppsala University Hospital in Sweden.

The current study did not address the potential for severe toxicities or negative effects on bowel function that can accompany high-dose radiation therapy. Dr. Folkesson said his research team has collected long-term morbidity data, but it has not yet been published.

"Basically, we have seen some increases in complaints and some hospital readmissions related to abdominal complaints after about eight years [postsurgery]," Dr. Folkesson said. "In the short term, the only differences are the healing rates of perineal wounds." After many years, there may also be an increase in secondary cancers among the irradiated group, he added.

"The benefits of radiotherapy are well known by now," Dr. Folkesson said. "We're now trying to sort out which patients are better candidates for it. It may be that patients don't benefit as much if they have early stage tumors or those [tumors] above 10 cm that get good clearance from good surgical technique."

ASCRS 2005 Annual Meeting: Abstract S1. Presented May 2, 2005.

Reviewed by Gary D. Vogin, MD

Jennifer Reid Holman is a freelance writer for Medscape.

    
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