中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (04): 293-296.

• 专题笔谈 • 上一篇    下一篇

局部复发直肠癌放射治疗

高献书,李洪振   

  1. 北京大学第一医院肿瘤放射治疗科,北京100034
  • 出版日期:2011-04-01 发布日期:2011-05-30

  • Online:2011-04-01 Published:2011-05-30

摘要:

局部复发是直肠癌,尤其是Ⅱ/Ⅲ期直肠癌手术治疗失败的主要原因,且术后复发病例预后差。20世纪70年代开始局部进展期直肠癌手术前后辅助放化疗的相关研究。大量临床试验结果显示,术后或术前辅助性放化疗较单纯手术可降低局部复发率、提高保肛率和存活率,已经成为I类循证医学证据,作为局部进展期直肠癌的标准治疗方案。而术后局部复发的直肠癌放化疗,目前尚未取得较高级别的循证医学证据。美国国家癌症综合网络(NCCN)指南建议对复发直肠癌病人应该采用多学科合作的综合治疗方案。孤立的盆腔或吻合口复发,如果之前未接受过全量放疗,最适合的处理就是行术前放疗,同期化疗。有条件的医疗机构,可考虑行术前新辅助放化疗+手术切除+术中放疗。

关键词: 局部复发直肠癌, 放射治疗, 同步放化疗, 术中放疗

Abstract:

Radiotherapy of locally recurrent rectal cancer        GAO Xian-shu, LI Hong-zhen. Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
Corresponding author: LI Hong-zhen, E-mail:doclee0134@163.com
Abstract    Local recurrence is the most common clinical failure pattern of rectal cancer, especially in stage II/III rectal cancer cases. The prognosis of postoperative recurrence is poor. To prevent recurrence, related studies on adjuvant/neoadjuvant chemoradiotherapy of locally advanced rectal cancer after surgery started in the 1970s. A large number of clinical trial results showed that preoperative and postoperative adjuvant/neoadjuvant chemoradiotherapy of locally advanced rectal cancer may reduce local recurrence, improve sphincter rate and survival. The pattern of multiple discipline treatment has become an evidence-based medicine I class as a standard treatment options of locally advanced rectal cancer. Chemoradiotherapy of locally recurrent rectal cancer has not yet achieved a high level of evidence-based medicine. NCCN guidelines recommend against recurrent rectal cancer patients should be performed multidisciplinary and comprehensive treatment. For isolated recurrent pelvic or anastomosis, if patients have not received the full amount of radiation, the most appropriate treatment is preoperative radiotherapy, concurrent chemotherapy. In conditional medical institutions, preoperative neoadjuvant chemoradiotherapy plus surgery and intraoperative radiotherapy may be considered.

Key words: locally recurrent rectal cancer, radiotherapy, concurrent chemoradiotherapy, intraoperative radiotherapy