直肠癌病理标本大体肿瘤周边微小癌灶距离的测定
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摘要
目的:根据直肠癌病理标本分别测量大体肿瘤侧方、下方和上方微小癌灶距离(即临床靶体积,clinical target volume,CTV),为其放疗临床靶区体积边径设置提供科学依据。方法:分析2016年10月至2017年4月在湖南省肿瘤医院行全直肠系膜切除术(total mesorectal excision,TME)的直肠癌标本28例,测量其周边最远微小癌灶距大体肿瘤边缘最近距离值。通过MRI和即时手术标本对比计算"在体-离体"肿瘤退缩因子(R_1);"线结标记法"计算病理标本处理过程退缩因子(R_2)。对实测微小癌灶延伸距离采用两种退缩因子(R_1、R_2)校正后即为"在体"微小癌灶延伸距离(microcarcinoma extension measured in vivo,MEin vivo)。结果:28例患者中,在大体肿瘤侧方、下方和上方可观察到微小癌灶者分别为17例(60.7%)、3例(10.7%)和0。R_1平均值为0.913,R_2平均值为0.803。实测微小癌灶在直肠癌大体肿瘤下方最远距离经校正后为28 mm,在大体肿瘤侧方最远距离经校正后最大值为12.03 mm,最小值为3.13 mm,平均值为7.50 mm。28例患者侧方微小癌灶侵袭范围95%频数值在10 mm内。结论:直肠癌大体肿瘤侧方微小癌灶侵袭范围95%频数值在10 mm内,建议直肠癌后程高剂量放疗靶区在前后左右方向大体肿瘤体积(gross tumor volume,GTV)外扩成CTV时边径为10 mm。
Objective: To measure the distance of the lateral, inferior, and superior microfoci from a gross tumor in a pathological specimen and to provide scientific evidence for margin extension to form the clinical target volume(CTV) in high-dose radiotherapy for rectal cancer. Methods: Twenty-eight surgical specimens were collected from patients with rectal cancer who underwent total mesorectal excision(TME) in Hunan Cancer Hospital between October 2016 and April 2017. The nearest distance of the farthest peripheral microfoci from the gross tumor was measured. The in vivo-in vitro tumor retraction factor(R1) was calculated by measuring the ratio of the tumor's perpendicular depth based on magnetic resonance imaging and immediate surgical specimens. The retraction factor(R2) in the process of pathological specimen makeup was calculated by knot labeling. The distance of microfoci extension was calculated based on that measured in pathological specimens including corrections with R1 and R2 and record as microcarcinoma extension measured in vivo,MEin vivo. Results: Among the 28 pathological specimens, lateral, inferior, and superior microfoci were found in 17(60.7%),3(10.7%), and 0 cases, respectively. The mean R1 was 0.913 and mean R2 was 0.803. The farthest distance measured inferiorly was 28 mm in vivo after correction. The maximum, minimum, and mean measured lateral distances were 12.03 mm, 3.03 mm, and 7.50 mm after correction, respectively. The 95% frequency value was within 10 mm. Conclusions: The lateral microfoci extension was within 10 mm for 95% of the rectal cancer patients. The margin expansion to form the CTV was suggested to be 10 mm for a late-course boost of high-dose radiotherapy for rectal cancer.
Objective: To measure the distance of the lateral, inferior, and superior microfoci from a gross tumor in a pathological specimen and to provide scientific evidence for margin extension to form the clinical target volume(CTV) in high-dose radiotherapy for rectal cancer. Methods: Twenty-eight surgical specimens were collected from patients with rectal cancer who underwent total mesorectal excision(TME) in Hunan Cancer Hospital between October 2016 and April 2017. The nearest distance of the farthest peripheral microfoci from the gross tumor was measured. The in vivo-in vitro tumor retraction factor(R1) was calculated by measuring the ratio of the tumor's perpendicular depth based on magnetic resonance imaging and immediate surgical specimens. The retraction factor(R2) in the process of pathological specimen makeup was calculated by knot labeling. The distance of microfoci extension was calculated based on that measured in pathological specimens including corrections with R1 and R2 and record as microcarcinoma extension measured in vivo,MEin vivo. Results: Among the 28 pathological specimens, lateral, inferior, and superior microfoci were found in 17(60.7%),3(10.7%), and 0 cases, respectively. The mean R1 was 0.913 and mean R2 was 0.803. The farthest distance measured inferiorly was 28 mm in vivo after correction. The maximum, minimum, and mean measured lateral distances were 12.03 mm, 3.03 mm, and 7.50 mm after correction, respectively. The 95% frequency value was within 10 mm. Conclusions: The lateral microfoci extension was within 10 mm for 95% of the rectal cancer patients. The margin expansion to form the CTV was suggested to be 10 mm for a late-course boost of high-dose radiotherapy for rectal cancer.
引文
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[15]Ono C,Yoshinaga K,Enomoto M,et al.Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ[J].Dis Colon&Rectum,2002,45(6):744-749.
[16]Basnet S,Lou QF,Liu N,et al.Tumor deposit is an independent prognostic indicator in patients who underwent radical resection for colorectal cancer[J].J Cancer,2018,9(21):3979-3985.
[17]Lino-Silva LS,Salcedo-Hernandez RA,Gamboa-Dominguez A.Tumour budding in rectal cancer.A comprehensive review[J].Contemp Oncol(Pozn),2018,22(2):61-74.
[2]Mullaney TG,Lightner AL,Johnston M,et al.'Watch and wait'after chemoradiotherapy for rectal cancer[J].ANZ J Surg,2018,88(9):836-841.
[3]Burbach JP,den Harder AM,Intven M,et al.Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer:a systematic review and meta-analysis[J].Radiother Oncol,2014,113(1):1-9.
[4]Hawkins AT,Hunt SR.Watch and wait:is surgery always necessary for rectal cancer[J]?Curr Treat Options Oncol,2016,17(5):22.
[5]Habr-Gama A,Perez RO,Nadalin W,et al.Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy[J].Ann Surg,2004,240(4):711-717.
[6]Habr-Gama A,Gama-Rodrigues J,Sao Juliao GP,et al.Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation:impact of salvage therapy on local disease control[J].Int J Radiat Oncol Biol Phys,2014,88(4):822-828.
[7]Martens MH,Maas M,Heijnen LA,et al.Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer[J].J Natl Cancer Inst,2016,108(12):171.
[8]Appelt AL,Pl?en J,Harling H,et al.High-dose chemoradiotherapy and watchful waiting for distal rectal cancer:a prospective observational study[J].The Lancet Oncology,2015,16(8):919-927.
[9]Appelt AL,Ploen J,Vogelius IR,et al.Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy[J].Int J Radiat Oncol Biol Phys,2013,85(1):74-80.
[10]Madsen PM,Christiansen J.Distal intramural spread of rectal carcinomas[J].Dis Colon Rectum,1986,29(4):279-282.
[11]Williams NS,Dixon MF,Johnston D.Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum:A study of distal intramural spread and of patients'survival[J].Br J Surg,1983,70(3):150-154.
[12]Paty PB,Enker WE,Cohen AM,et al.Treatment of rectal cancer by low anterior resection with coloanal anastomosis[J].Ann Surg,1994,219(4):365-373.
[13]Karanjia ND,Schache DJ,North WRS,et al.'Close shave'in anterior resectio[J].Br J Surg,1990,77(5):510-512.
[14]Jin M,Frankel W L.Lymph node metastasis in colorectal cancer[J].Surg Oncol Clin N Am,2018,27(2):401-412.
[15]Ono C,Yoshinaga K,Enomoto M,et al.Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ[J].Dis Colon&Rectum,2002,45(6):744-749.
[16]Basnet S,Lou QF,Liu N,et al.Tumor deposit is an independent prognostic indicator in patients who underwent radical resection for colorectal cancer[J].J Cancer,2018,9(21):3979-3985.
[17]Lino-Silva LS,Salcedo-Hernandez RA,Gamboa-Dominguez A.Tumour budding in rectal cancer.A comprehensive review[J].Contemp Oncol(Pozn),2018,22(2):61-74.