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背景与目的:直肠癌是常见的肿瘤,手术是其主要的治疗方法,辅助放疗能提高Ⅱ/Ⅲ期直肠癌的局控率。但放疗剂量的增加是否能进一步提高局控率并对生存率有所改善尚不明确。本研究观察Ⅱ/Ⅲ期直肠癌根治术后辅助放疗的疗效,探讨是否存在肿瘤局控与剂量效应关系。方法:回顾性分析1993年7月至2001年12月间Ⅱ/Ⅲ期直肠癌接受术后放射治疗的病例74例。Ⅱ期32例,Ⅲ期42例。放射治疗常规分割1.8~2.0 Gy/次,总剂量40~70 Gy,中位剂量54 Gy。全组中有62例患者接受了以氟尿嘧啶为基础的辅助化疗1~10疗程。应用SPSS11.5统计软件,Kap lan-M e ier法进行生存分析。结果:全组中位随访时间44.6个月(7.3~119.9个月),全组5年生存率和无瘤生存率分别为58%和60%。局部复发14例,远处转移17例。将全组按剂量分为≤50 Gy,51-60Gy,>60 Gy 3组,5年局控率分别为92%,71%和87%(P=0.9194);5年生存率分别为68%,62%和53%(P=0.4194),3组间未显示有统计学差异。共有5例因并发症而死亡,接受的放疗剂量均大于50 Gy。结论:Ⅱ、Ⅲ直肠癌根治术后辅助放疗未显示有剂量效应,剂量增加未提高局控率和生存率。常规分割放疗时以50 Gy为宜,过高的剂量有增加并发症发生的危险。
BACKGROUND & OBJECTIVE: Rectal cancer is a common tumor, and surgery is its main treatment. Adjuvant radiotherapy can improve the local control rate of rectal cancer in stage II/III. However, whether the increase in the dose of radiotherapy can further increase the rate of control and improve the survival rate is not yet clear. This study observed the efficacy of adjuvant radiotherapy after radical resection of stage II/III rectal cancer, and investigated whether there is a relationship between local tumor control and dose effects. Methods: Seventy-four cases of stage II/III rectal cancer received postoperative radiotherapy between July 1993 and December 2001 were retrospectively analyzed. There were 32 cases in stage II and 42 cases in stage III. Radiotherapy was routinely divided 1.8-2.0 Gy/time, with a total dose of 40-70 Gy and a median dose of 54 Gy. Sixty-two patients in the whole group received 1-5 courses of fluorouracil-based adjuvant chemotherapy. SPSS11.5 statistical software and Kap lan-Meier method were used for survival analysis. Results: The median follow-up time of the whole group was 44.6 months (7.3 to 119.9 months). The 5-year survival rate and disease-free survival rate of the whole group were 58% and 60%, respectively. There were 14 cases of local recurrence and 17 cases of distant metastases. The whole group was divided into ≤50 Gy, 51-60 Gy, and >60 Gy 3 groups according to the dose. The 5-year rate was 92%, 71%, and 87% (P=0.9194). The 5-year survival rate was 68%. , 62% and 53% (P=0.4194), there was no statistical difference between the 3 groups. A total of 5 patients died of complications and received radiation doses greater than 50 Gy. Conclusion: The adjuvant radiotherapy after radical resection of rectal cancers II and III did not show a dose effect. The increase in dose did not improve the local control rate and survival rate. 50 Gy is appropriate for conventional fractionated radiotherapy. Excessive doses increase the risk of complications.