The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis
The role of neoadjuvant radiotherapy for locally-advanced rectal cancer with resectable synchronous metastasis
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DOI：
10.21037/jgo.2017.06.07
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发表时间：
2017-08-01
影响因子：
2.1
通讯作者：
Larson, David W.
中科院分区：
文献类型：
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作者：
Fossum, Croix C.;Alabbad, Jasim Y.;Larson, David W.
背景：虽然新辅助放疗通常用于局部晚期直肠癌以减少局部复发（LR），但其在伴有可切除肝和/或肺转移的患者中的作用尚不明确。本研究的目的是评估新辅助放疗对IV期直肠癌患者进行治疗目的手术的作用。方法：本研究回顾性分析了1990年1月至2014年12月在明尼苏达州罗切斯特市梅奥诊所接受治疗目的切除的所有连续成年患者的前瞻性手术登记，中位随访时间为43个月（IQR 16-67）。符合条件的患者为局部晚期直肠癌（T3、T4和/或淋巴结受累），同时伴有可切除的肝和/或肺转移。排除标准为：原发肿瘤分期为T1N0或T2N0的患者，转移到肝、肺以外器官的患者，姑息性切除患者，同步转移的非手术治疗（如射频消融）患者，术后放疗患者，或未获得研究授权的患者。纳入93例患者，其中47例接受新辅助放疗，46例未接受新辅助放疗。所有患者均接受新辅助化疗+/-放疗，然后进行治疗目的手术，转移切除术与原发肿瘤切除术同时进行，或作为计划的分期切除术。本研究的主要结果是LR、远处转移、总生存期和疾病特异性生存期（DSS）。结果：未接受放疗的患者有12例（26%）出现LR，而接受新辅助放疗的患者无LR发生，P< 0.001。单因素分析显示，年龄、性别、ASA类别、BMI、肿瘤位置、手术或新辅助化疗与随后的LR无关。未放疗组5年总生存率（OS）为43.3% (95% CI: 30.1, 62.3)，放疗组为58.3% （95% CI: 43.4, 78.2）。结论：局部晚期IV期直肠癌患者应考虑新辅助放疗。这些数据增加了支持新辅助放射治疗可切除转移性疾病的证据。
Background: Although neoadjuvant radiotherapy is typically administered for locally-advanced rectal cancer to reduce local recurrence (LR), its role for patients who present with synchronous resectable liver and/or lung metastasis is not well defined. The aim of this study was to evaluate the role of neoadjuvant radiotherapy for patients with stage IV rectal cancer undergoing curative-intent surgery.Methods: This study is a retrospective review of a prospectively maintained surgical registry of all consecutive adult patients who underwent curative-intent resection at Mayo Clinic in Rochester, MN, from January 1990 until December 2014 with a median follow-up time of 43 (IQR 16-67) months. Eligible patients had locally-advanced rectal cancer (T3, T4 and/or nodal involvement) with synchronous resectable liver and/or lung metastasis. Exclusion criteria were as follows: patients with primary tumor stage of T1N0 or T2N0, patients with metastasis to organs other than the liver or lung, patients who had palliative resection, patients who had non-surgical treatment of synchronous metastasis (e.g., radiofrequency ablation), patients who received postoperative radiotherapy, or absence of research authorization. Ninety three patients were included of which 47 received neoadjuvant radiotherapy and 46 did not. All patients received neoadjuvant chemotherapy +/- radiotherapy followed by curative-intent surgery with metastasectomy performed either simultaneously with resection of the primary tumor or as a planned staged resection. The primary outcomes of this study are LR, distant metastasis, overall and disease-specific survival (DSS).Results: LR was observed in 12 patients (26%) who did not receive radiotherapy, while no LR developed in those who received neoadjuvant radiotherapy, P< 0.001. Univariate analysis showed that neither age, sex, ASA class, BMI, tumor location, procedure performed, or neoadjuvant chemotherapy were associated with subsequent LR. The 5-year overall survival (OS) rates were: 43.3% (95% CI: 30.1, 62.3) for no radiotherapy vs. 58.3% (95% CI: 43.4, 78.2) with radiotherapy.Conclusions: Neoadjuvant radiotherapy should be considered in patients with locally-advanced stage IV rectal cancer. These data add to the evidence supporting neoadjuvant radiotherapy in the setting of resectable metastatic disease.