Clinicopathological outcomes of preoperative chemoradiotherapy using S-1 plus Irinotecan for T4 lower rectal cancer
Clinicopathological outcomes of preoperative chemoradiotherapy using S-1 plus Irinotecan for T4 lower rectal cancer
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DOI：
10.1007/s00595-015-1250-z
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发表时间：
2016-07-01
期刊：
影响因子：
2.5
通讯作者：
Yamanaka, Naoki
中科院分区：
文献类型：
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作者：
Beppu, Naohito;Yoshie, Hidenori;Yamanaka, Naoki
目的探讨术前S-1联合伊立替康放化疗对T4低位直肠癌患者的临床病理效果。方法2005 - 2011年，35例T4M0下段直肠癌患者接受45 Gy放疗联合S-1 +伊立替康治疗，其中12例为T4a， 23例为T4b。中位随访期为50.6个月（2-123个月）。结果32例（91.4%）患者完成放疗，26例（74.3%）患者完成全化疗方案。排除2例肉眼可见残余病变的患者后，35例患者中有33例（94.3%）行根治性手术。12例患者病理诊断均由T4a降至ypT0-3(100%)， 23例患者中20例由T4b降至ypT0-4a（87.0%）。肿瘤消退等级1a/1b/2/3（完全缓解）分别为10/8/15/2。长期生存方面，5年局部无复发生存率为74.8%，无复发生存率为52.0%。结论：该方案可降低分期。此外，在本研究中，术前放化疗后累及邻近器官的病理证据在初始阶段诊断为T4b的患者中很少见。
Purpose To investigate the clinicopathological outcomes of patients with T4 lower rectal cancer treated using preoperative chemoradiotherapy with S-1 plus Irinotecan.Methods Between 2005 and 2011, 35 patients with T4M0 lower rectal cancer, diagnosed initially as T4a in 12 and as T4b in 23, were treated with 45 Gy of radiotherapy concomitantly with S-1 plus Irinotecan. The median follow-up period was 50.6 months (range 2-123 months).Results A total of 32 patients (91.4 %) completed the radiotherapy and 26 (74.3 %) completed the full chemotherapy regimen. Radical surgery was then performed in 33 (94.3 %) of the 35 patients after the exclusion of two patients, who had macroscopic residual disease. The pathological diagnosis was downstaged from T4a to ypT0-3 in all 12 of those patients (100 %) and from T4b to ypT0-4a in 20 of those 23 patients (87.0 %). The tumor regression grade of 1a/1b/2/3 (complete response) was 10/8/15/2, respectively. In terms of long-term survival, the 5-year local relapse-free survival rate was 74.8 % and the recurrence-free survival rate was 52.0 %.Conclusions This regimen may result in favorable down-staging. Moreover, in this series, pathological evidence of involvement of adjacent organs was rare following preoperative chemoradiotherapy, in the patients with disease diagnosed as T4b at the initial staging.