CAJ | 학술논문

目的：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
목적：평고화비교보조성술전、술후방료재직장암치료중적작용。방법：1988년2월～1995년2월수치경병리증실적직장암176례，배합수술분별채용술전단차방료、술전상규방료화술후방료。술전단차방료조38례，제량위5Gy，병우방료후48h내수술；술전40Gy상규방료조43례，다위림상만기(T3～4점60.5%)，중위제량40Gy，방료후휴4주재행수술；술후방료조95례，이병변만기화림파결양성위주(T3～4점62.1%，T2～4N＋점81.1%)，채용중위제량54Gy상규분할，료정약6주，수술후3～4주개시접수방료。결과：전부병례평균수방84개월，Kaplan-Meier법계산생존솔。술전단차방료조3년、5년생존솔분별위78.9%화50.0%，상규술전40Gy방료조위67.4%화51.1%；술후방료조위58.9%화43.1%；3조적3년、5년국부복발솔분별위13.1%화23.6%、11.6%화27.9%급23.1%화28.4%。경Logrank검험，결과표명2조술전방료적3년국부복발솔명현저우술후방료조(P<0.05)，량자적5년국부복발솔급3년、5년생존솔무명현차이。경χ2검험，술전단차방료조화술전상규방료조적급성급원기부반응균명현저우술후방료조。결론：괄당제량적술전방료여술후방료상비，전자구유교고적국부공제솔화교저적방료후부반응
Objective:　To evaluate and compare the effects of pre- and postoperative radiotherapy on rectal cancer. Methods:　One hundred and seventy-six cases of histologically proved rectal cancer admitted from February 1988 to February 1995, were divided into 3 groups. Group one: 38 patients(T2:68.4%) were treated with a single fraction preoperative radiotherapy, with a tumor dose of 5 Gy; operation was performed within 48 hours. Group two: 43 patients(T3～4:60.5%) were treated by the conventional preoperative radiotherapy regimen with a median tumor dose of 40Gy in 20 fractions, with a daily dose of 1.8～2Gy, followed by surgery within 4 weeks. Group three: 95 patients(T3～4:62.1%,T2～4N＋:81.1%) underwent postoperative radiotherapy with a median tumor dose of 54Gy in 30 fractions, with a daily dose of 1.8Gy, 3～4 weeks after surgery. Results:　The 3-yr and 5-yr survival rates were: 78.9% and 50.0% in group one, 67.4% and 51.1% in group two, 58.9% and 43.1% in group three. Local recurrence rates were:13.1% and 23.6% , 11.6% and 27.9%, 23.1% and 28.4% in the 3 groups, respectively. Only the 3-yr local recurrence rate of the two preoperative radiotherapy groups were significantly lower than those of the postoperative radiotherapy group (P<0.05). Conclusions:　Compared with the postoperative radiotherapy regimen, preoperative radiotherapy with a proper dosage had better local control and fewer complications.