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评估和比较辅助性术前、术后放疗在直肠癌治疗中的作用。方法：1988年2月～1995年2月收治经病理证实的直肠癌176例，配合手术分别采用术前单次放疗、术前常规放疗和术后放疗。术前单次放疗组38例，剂量为5Gy，并于放疗后48h内手术；术前40Gy常规放疗组43例，多为临床晚期(T3～4占60.5%)，中位剂量40Gy，放疗后休4周再行手术；术后放疗组95例，以病变晚期和淋巴结阳性为主(T3～4占62.1%，T2～4N＋占81.1%)，采用中位剂量54Gy常规分割，疗程约6周，手术后3～4周开始接受放疗。结果：全部病例平均随访84个月，Kaplan-Meier法计算生存率。术前单次放疗组3年、5年生存率分别为78.9%和50.0%，常规术前40Gy放疗组为67.4%和51.1%；术后放疗组为58.9%和43.1%；3组的3年、5年局部复发率分别为13.1%和23.6%、11.6%和27.9%及23.1%和28.4%。经Logrank检验，结果表明2组术前放疗的3年局部复发率明显低于术后放疗组(P<0.05)，两者的5年局部复发率及3年、5年生存率无明显差异。经χ2检验，术前单次放疗组和术前常规放疗组的急性及远期副反应均明显低于术后放疗组。结论：适当剂量的术前放疗与术后放疗相比，前者具有较高的局部控制率和较低的放疗后副反应。
To evaluate and compare the role of adjuvant preoperative and postoperative radiotherapy in the treatment of rectal cancer. Methods: From March 1988 to February 1995, 176 cases of pathologically confirmed rectal cancer were treated with radiotherapy, preoperative routine radiotherapy and postoperative radiotherapy. Preoperative single radiotherapy group of 38 patients, the dose of 5Gy, and surgery within 48h after radiotherapy; preoperative 40Gy conventional radiotherapy group of 43 cases, mostly late clinical (T3 ~ 4 accounted for 60.5%), the median dose of 40Gy, after radiotherapy Rest surgery after 4 weeks of rest; Postoperative radiotherapy group of 95 cases, with advanced lesions and lymph node positive (62.1% T3 ~ 4, T2 ~ 4N+ accounted for 81.1%), using a median dose of 54Gy conventional segmentation, treatment for about 6 weeks, surgery After 3 to 4 weeks, radiotherapy began. Results: All patients were followed for an average of 84 months. The Kaplan-Meier method was used to calculate the survival rate. The 3-year and 5-year survival rates of the preoperative single radiotherapy group were 78.9% and 50.0%, respectively, 67.4% and 51.1% in the routine preoperative 40 Gy radiotherapy group, 58.9% and 43.1% in the postoperative radiotherapy group, and 3 years in the 3 group. The 5-year local recurrence rates were 13.1% and 23.6%, 11.6% and 27.9%, and 23.1% and 28.4%, respectively. The Logrank test showed that the 3-year local recurrence rate of preoperative radiotherapy in the 2 groups was significantly lower than that of the postoperative radiotherapy group (P<0.05). There was no significant difference in the 5-year local recurrence rate and 3-year and 5-year survival rates between the two groups. After the χ2 test, the acute and long-term side effects of the preoperative single radiotherapy group and the preoperative conventional radiotherapy group were significantly lower than the postoperative radiotherapy group. Conclusion: Compared with postoperative radiotherapy, preoperative radiotherapy with appropriate dose has higher local control rate and lower side effects after radiotherapy.