A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis
A favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis
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DOI：
10.1016/s0959-8049(02)00557-9
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发表时间：
2003-01-01
影响因子：
8.4
通讯作者：
Mulder, NH
中科院分区：
文献类型：
--
作者：
Reerink, O;Verschueren, RCJ;Mulder, NH
局部晚期直肠癌的初始治疗侧重于局部控制，因为直肠癌的局部复发与高发病率和死亡率相关。我们研究了新辅助放化疗对晚期直肠癌患者的影响，与降级、局部复发和生存率的关系。对来自一家机构的66例患者进行了治疗后病理分期、局部复发和生存分析。43例患者通过剖腹手术（n = 42）或直肠检查（n = 1）确定为不可切除的癌症。这43名患者在术前接受45-56戈伊5-氟尿嘧啶（5-FU）和甲酰四氢叶酸（350/20 mg/m2 × 5天（d）），在放射治疗期间的第1周和第5周。23名患者患有T1-2期原发性可切除肿瘤。在最初不可切除的肿瘤中，79%在肉眼下可切除，74%进行了R 0切除。在34例手术标本中，6例（18%）未发现肿瘤（pT 0），7例患者有小肿瘤残留（pT 1 -2）。在这些pT 0 -2肿瘤中，未发生局部复发（中位观察期为4.5年，范围为18-87个月）。在21例pT 3 -4肿瘤患者中，观察到3例局部复发。在23例原发可切除的T1-2肿瘤患者中，复发率为4%。将最初不可切除的直肠肿瘤降级至pT 2或更低，导致局部复发率和总生存率与具有相同T分类的原发性可切除癌症的比率相对应。(C)2002爱思唯尔科技有限公司。保留所有权利。
Initial treatments of locally advanced rectal cancers focus on local control, as local relapse of a rectal cancer is correlated with a high morbidity and mortality. We studied the effect of neoadjuvant radiochemotherapy on advanced rectal cancer patients in relation to downstaging, local relapse and survival. Post-treatment pathological staging, local relapse and survival were analysed in 66 patients from a single institution. 43 patients had irresectable cancer as determined by laparatomy (n = 42) or rectal examination (n = 1). These 43 patients received 45-56 Gy preoperatively with 5-fluorouracil (5-FU) and leucovorin (350/20 mg/m(2) x 5 day (d)) in weeks I and 5 during the radiation therapy. 23 patients had primary resectable tumours with a T1-2 stage. Of the initially irresectable tumours 79% became macroscopically resectable, in 74% a R0 resection was performed. In 6 of 34 (18%) surgical specimens, no tumour was found (pT0), 7 patients had small tumour remnants (pT1-2). In these pT0-2 tumours, no local relapses occurred (observation period of median 4.5 years, range 18-87 months). In the 21 patients with pT3-4 tumours 3 local relapses were seen. In the 23 patients with primary resectable T1-2 tumours the relapse rate was 4%. Downstaging of an initially irresectable rectal tumour to pT2 or less results in a local relapse rate and overall survival that correspond with the rates in primary resectable cancer with the same T classification. (C) 2002 Elsevier Science Ltd. All rights reserved.