Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer
Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer
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DOI：
10.1186/1471-2407-12-592
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发表时间：
2012-12-11
期刊：
影响因子：
3.8
通讯作者：
Debus, Juergen
中科院分区：
文献类型：
--
作者：
Roeder, Falk;Goetz, Joerg-Michael;Debus, Juergen
背景：评价经IOERT综合治疗后局部复发直肠癌患者的疾病控制率、总生存期和预后因素。方法：1991-2006年间，97例局部复发直肠癌患者接受了手术加IOERT治疗。在IOERT之前或之后，54例未接受治疗的患者(中位剂量为41.4GY)在IOERT之前或之后接受外照射(EBRT)，通常联合5-氟尿嘧啶为主的化疗(89%)。IOERT采用圆柱形锥体给药，剂量为10~20Gy.仅有少数患者(34%)接受了辅助性CHT。中位随访时间51个月。结果：切缘状态为R0者占37%，R1者占33%，R2者占30%。新辅助EBRT导致自由利润率显著增加(52%比24%)。中位总生存期为39个月。估计中央控制(在IOERT区域内)、局部控制(在骨盆内)、远程控制和总存活率分别为54%、41%、40%和30%。在多因素模型中，切除边缘是影响总生存率(3年OS分别为80%(R0)、37%(R1)、35%(R2))和LC(3年LC为82%(R0)、41%(R1)、18%(R2))的最强预后因素。在单因素模型中，初诊时的临床分期和治疗后取得局部控制的情况对OS有显著影响。在46名患者中发现了远距离衰竭，主要是在肺部。术后90天的死亡率为3.1%。结论：在大部分直肠癌复发患者中，采用包含IOERT的多模式手术可以获得长期的OS和LC，特别是在切缘清晰的情况下。LC和OS在不完全切除的患者中仍然有限。可考虑术前再次放疗和辅助化疗以改善预后。
Background: To evaluate disease control, overall survival and prognostic factors in patients with locally recurrent rectal cancer after IOERT-containing multimodal therapy.Methods: Between 1991 and 2006, 97 patients with locally recurrent rectal cancer have been treated with surgery and IOERT. IOERT was preceded or followed by external beam radiation therapy (EBRT) in 54 previously untreated patients (median dose 41.4 Gy) usually combined with 5-Fluouracil-based chemotherapy (89%). IOERT was delivered via cylindric cones with doses of 10-20 Gy. Adjuvant CHT was given only in a minority of patients (34%). Median follow-up was 51 months.Results: Margin status was R0 in 37%, R1 in 33% and R2 in 30% of the patients. Neoadjuvant EBRT resulted in significantly increased rates of free margins (52% vs. 24%). Median overall survival was 39 months. Estimated 5-year rates for central control (inside the IOERT area), local control (inside the pelvis), distant control and overall survival were 54%, 41%, 40% and 30%. Resection margin was the strongest prognostic factor for overall survival (3-year OS of 80% (R0), 37% (R1), 35% (R2)) and LC (3-year LC 82% (R0), 41% (R1), 18% (R2)) in the multivariate model. OS was further significantly affected by clinical stage at first diagnosis and achievement of local control after treatment in the univariate model. Distant failures were found in 46 patients, predominantly in the lung. 90-day postoperative mortality was 3.1%.Conclusion: Long term OS and LC can be achieved in a substantial proportion of patients with recurrent rectal cancer using a multimodality IOERT-containing approach, especially in case of clear margins. LC and OS remain limited in patients with incomplete resection. Preoperative re-irradiation and adjuvant chemotherapy may be considered to improve outcome.