The Addition of Preoperative Radiation Is Insufficient for Lateral Pelvic Control in a Subgroup of Patients With Low Locally Advanced Rectal Cancer: A Post Hoc Study of a Randomized Controlled Trial.
The Addition of Preoperative Radiation Is Insufficient for Lateral Pelvic Control in a Subgroup of Patients With Low Locally Advanced Rectal Cancer: A Post Hoc Study of a Randomized Controlled Trial.
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在低度局部晚期直肠癌亚组患者中，增加术前放疗不足以实现侧骨盆控制：一项随机对照试验的事后研究。
DOI：
10.1097/dcr.0000000000001935
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发表时间：
2021
影响因子：
3.9
通讯作者：
Luo Yanxin
中科院分区：
文献类型：
--
作者：
Xie Yumo;Lin Jinxin;Wang Xiaolin;Wang Puning;Zhuang Zhuokai;Zou Qi;Cai Du;Huang Zenghong;Bai Liangliang;Tang Guannan;Huang Meijin;Wang Jianping;Yu Huichuan;Luo Yanxin
背景：新辅助放化疗后行全直肠系膜切除可改善直肠癌局部复发。然而，在低局部进展期直肠癌患者中，盆腔外侧复发仍有待解决。目的：本研究旨在确定新辅助放疗在解决盆腔外侧复发的效率，以及哪些患者亚组可能是最佳的接受侧方淋巴结清扫术。设计：MRI/CT图像进行了重新评估侧方淋巴结状态。治疗前和再分期MRI/CT.SETTING：这是一个前瞻性随机对照试验（FOWARC，NCT 01211210）的事后分析。患者：共有495例II或III期直肠腺癌患者被纳入原试验。根据排除标准，最终纳入的人群包括253例患者，其中195例接受新辅助放化疗和94例接受chemotherapy.Main结局和测量：主要结局是5年盆腔外侧复发率。结果：与接受单独化疗的患者相比，接受额外放疗的患者盆腔外侧复发率较低（6.6% vs 13.0%; p= 0.051）。在治疗前侧方淋巴结阳性的亚组中，患者在新辅助放化疗和单纯化疗后的侧方盆腔复发率分别为22.6%和45.1%。值得注意的是，34.9%的治疗前阳性侧淋巴结在新辅助放化疗后持续存在，最终导致侧盆腔复发率为63.3%。局限性：这是一项事后分析，仅纳入了来自领先中心的患者，这限制了样本量。此外，外侧淋巴结清扫术没有在这个cohol.CONCLUSIONS：在新辅助治疗方案中增加放疗不能充分解决盆腔外侧复发。一些亚组的患者可能需要额外的夹层。请参阅https：//links上的视频摘要。lww。com/DCR/B613。
BACKGROUND:The local recurrence of rectal cancer has been improved by total mesorectal excision following neoadjuvant chemoradiotherapy. However, in patients with low locally advanced rectal cancer, lateral pelvic recurrence remains to be addressed.OBJECTIVE:This study aimed to determine the efficiency of neoadjuvant radiotherapy in addressing lateral pelvic recurrence and which subgroup of patients might be optimal to receive lateral lymph node dissection.DESIGN:The MRI/CT images were reassessed for lateral lymph node status. The lateral lymph nodes with short axis≥ 5 mm and≥ 4 mm were considered positive in pretreatment and restaging MRI/CT.SETTING:This was a post hoc analysis of a prospective randomized controlled trial (FOWARC, NCT01211210).PATIENTS:A total of 495 patients with stage II or III rectal adenocarcinoma were included in the original trial. According to the excluding criteria, the finally included population consists of 253 patients; of these, 195 patients received neoadjuvant chemoradiotherapy and 94 received chemotherapy alone.MAIN OUTCOMES AND MEASURES:The primary outcome was the 5-year lateral pelvic recurrence rate.RESULTS:Compared with patients receiving chemotherapy alone, patients receiving additional radiotherapy had a marginal significance of lower lateral pelvic recurrence rate (6.6% vs 13.0%; p= 0.051). In the subset with pretreatment positive lateral lymph nodes, patients had a lateral pelvic recurrence rate of 22.6% and 45.1% after neoadjuvant chemoradiotherapy and chemotherapy alone. Of note, 34.9% of the pretreatment positive lateral lymph nodes were persistent after neoadjuvant chemoradiotherapy, culminating in a lateral pelvic recurrence rate of 63.3%.LIMITATIONS:This is a post hoc analysis, and only the patients from the leading center were included, which limited the sample size. In addition, the lateral lymph node dissection was not performed in this cohort.CONCLUSIONS:The addition of radiotherapy in neoadjuvant regimens could not address lateral pelvic recurrence adequately. Some subgroups of patients might need additional dissection. See Video Abstract at https://links. lww. com/DCR/B613.