Pasetto Lara Maria, Friso Maria Luisa, Pucciarelli Salvatore, Basso Umberto, Toppan Paola, Rugge Massimo, Sinigaglia Giulietta, Nitti Donato, Sotti Guido, Monfardini Silvio
Medical Oncology Department, Via Gattamelata 64, Istituto Oncologico Veneto, 35128 Padova, Italy.
Anticancer Res. 2007 Mar-Apr;27(2):1079-85.
Rectal cancer is commonly diagnosed at a precocious stage, but for patients presenting at diagnosis with stage IV disease the best treatment is still undefined. The purpose of this study was to review the feasibility and outcome of multimodality treatment of rectal cancer patients metastatic at diagnosis.
From January 2000 to December 2005, 40 patients with histologically proven stage IV rectal adenocarcinoma (< 12 cm from the anal verge) were examined. Variables considered were age (under or over 65 years), tumour grade, presence of peritoneal carcinomatosis, type of surgery (palliative versus resection).
The median age was 61 years (range, 32-83) and 27 were male and 13 female. Seventeen patients with unresectable or potentially resectable metastatic disease received neoadjuvant chemoradiotherapy (CHT-RT) with 5-fluorouracil (5FU) (plus oxaliplatin in 11 cases), radical surgery was performed in almost half of the cases; only in two patients were metastases also resected. If the patient is a candidate for radical surgical resection, the primary tumour should initially be treated as in a patient without metastatic disease and subsequently the primary tumour and metastases should be treated surgically. If the metastases are unresectable, the treatment of the primary lesion, according to the patient's symptoms, should be by palliative CHT. It is still not determined whether RT should be reserved for the symptomatic cases as an alternative to local surgery. In five patients treated with neoadjuvant CHT alone, radical local surgery was performed in two cases. Eighteen symptomatic patients were resected primarily; all of them received a postoperative CHT but only five of them also received postoperative RT. Nevertheless, after a multimodality treatment (neoadjuvant CHT +/- RT) 22.5% achieved a response rate (RR) (one complete remission (CR) and eight partial remission (PR)). Considering that all except two of the patients were locally radically resected and two of them also underwent metastases surgery, the overall RR was 17.5% (four CR and three PR). All of the CR were disease-free and alive after a median follow-up of 19.3 months. Age > or = 65 years had no impact on overall survival (OS), but the presence of peritoneal carcinosis in five patients showed a trend towards diminished survival, although it was not statistically significant (p = 0.08).
The best treatment on diagnosis of metastatic rectal cancer is a multimodality CHT-RT approach. New prospective studies should evaluate non cross-resistant regimens as additional therapy for those patients with a systemic residual disease after common CHT-RT.
直肠癌通常在早期被诊断出来，但对于诊断时已处于IV期疾病的患者，最佳治疗方案仍不明确。本研究的目的是回顾诊断时已发生转移的直肠癌患者多模式治疗的可行性和结果。
2000年1月至2005年12月，对40例经组织学证实为IV期直肠腺癌（距肛缘<12 cm）的患者进行了检查。考虑的变量包括年龄（65岁以下或以上）、肿瘤分级、腹膜癌转移情况、手术类型（姑息性手术与根治性手术）。
中位年龄为61岁（范围32 - 83岁），男性27例，女性13例。17例不可切除或潜在可切除的转移性疾病患者接受了新辅助放化疗（CHT-RT），使用5-氟尿嘧啶（5FU）（11例加用奥沙利铂），近一半患者进行了根治性手术；仅2例患者的转移灶也被切除。如果患者是根治性手术切除的候选者，原发肿瘤最初应按照无转移性疾病患者的治疗方法进行治疗，随后对原发肿瘤和转移灶进行手术治疗。如果转移灶不可切除，根据患者症状，原发灶应采用姑息性CHT治疗。对于有症状的病例，放疗是否应作为局部手术的替代方法保留使用仍未确定。在仅接受新辅助CHT治疗的5例患者中，2例进行了根治性局部手术。18例有症状的患者首先接受了手术切除；他们均接受了术后CHT，但仅5例还接受了术后放疗。然而，经过多模式治疗（新辅助CHT±放疗），22.5%的患者达到了缓解率（RR）（1例完全缓解（CR）和8例部分缓解（PR））。考虑到除2例患者外所有患者均进行了局部根治性切除，其中2例还进行了转移灶手术，总体RR为17.5%（4例CR和3例PR）。所有CR患者在中位随访19.3个月后均无病存活。年龄≥65岁对总生存期（OS）无影响，但5例存在腹膜癌转移的患者生存期有缩短趋势，尽管差异无统计学意义（p = 0.08）。
转移性直肠癌诊断时的最佳治疗方法是多模式CHT-RT方案。新的前瞻性研究应评估非交叉耐药方案，作为那些在常规CHT-RT后仍有全身残留疾病患者的额外治疗方法。
