Radu Calin, Berglund Ake, Påhlman Lars, Glimelius Bengt
Department of Oncology, Radiology and Clinical Immunology, Uppsala University Hospital, Upssala, Sweden.
Radiother Oncol. 2008 Jun;87(3):343-9. doi: 10.1016/j.radonc.2007.11.025. Epub 2008 Feb 21.
In the most advanced, non-resectable primary rectal cancers, conventional long-course radiotherapy (RT) (1.8-2Gyx25-28), frequently combined with chemotherapy, has been used since tumour regression is needed in order to allow a radical (R0) resection. In Uppsala, short-course 5x5Gy with planned delayed surgery has been used in patients with contraindications to long-course RT (+/-chemotherapy). The aim is to describe our experience of using this approach in patients not eligible for standard treatment.
During 2002 and 2005, 46 patients with non-resectable rectal cancer (+/-synchronous distant metastases) were treated with 5x5Gy and delayed surgery if possible. The clinical records were retrospectively evaluated. The first group (A) had no metastases (T4NXM0), whereas the other two groups (B+C) had metastases (T4NXM1). In group (B), the patients had predominantly loco-regional disease and were not candidates for combination chemotherapy (high age, co-morbidities), and in group (C) up-front combination chemotherapy was given, with the intention to have surgery of both the primary and the secondaries if sufficient regression at both sites were seen.
The patients in the first two groups (A+B) were old (median 79 and 76 years, respectively), and had several co-morbidities. In group (C), median age was 63 years. The 5x5Gy RT was well tolerated by most patients, but grade IV diarrhoea was recorded in three elderly patients. One patient in the group (C) died from neutropenic fever. Many patients were reported to have less local symptoms after the treatment given. Delayed surgery was performed in all but nine patients. Radical surgery (R0+R1) was performed in 22 (92%) (group A), 4 (44%) (group B), and 6 (46%) (group C) patients, respectively. A pCR was seen in four patients (two in group A and two in group C). No postoperative deaths occurred.
Considering the very high age and presence of co-morbidity, the 5x5Gy schedule is well tolerated. Further, considering the very advanced local stage, the schedule has considerable anti-tumour activity and can result in radical surgery in a high proportion of patients.
在最晚期、不可切除的原发性直肠癌中，传统的长程放疗（RT）（1.8 - 2Gy×25 - 28次）常与化疗联合使用，因为需要肿瘤退缩以实现根治性（R0）切除。在乌普萨拉，对于有长程放疗禁忌证的患者（±化疗），采用了5×5Gy的短程放疗并计划延迟手术。目的是描述我们在不符合标准治疗的患者中使用这种方法的经验。
在2002年至2005年期间，46例不可切除的直肠癌患者（±同步远处转移）接受了5×5Gy的放疗，并尽可能延迟手术。对临床记录进行了回顾性评估。第一组（A）无转移（T4NXM0），而另外两组（B + C）有转移（T4NXM1）。在B组中，患者主要为局部区域疾病，不适合联合化疗（高龄、合并症），在C组中，给予一线联合化疗，目的是如果在原发灶和转移灶均出现足够的退缩，则对两者进行手术。
前两组（A + B）的患者年龄较大（中位年龄分别为79岁和76岁），且有多种合并症。在C组中，中位年龄为6三岁。大多数患者对5×5Gy的放疗耐受性良好，但有3例老年患者出现了IV级腹泻。C组中有1例患者死于中性粒细胞减少性发热。据报道，许多患者在接受治疗后局部症状减轻。除9例患者外，其余患者均进行了延迟手术。分别在22例（92%）（A组）、4例（44%）（B组）和6例（46%）（C组）患者中进行了根治性手术（R0 + R1）。4例患者出现了病理完全缓解（pCR）（A组2例，C组2例）。无术后死亡发生。
考虑到患者年龄极高且存在合并症，5×5Gy的放疗方案耐受性良好。此外，考虑到局部分期非常晚，该方案具有相当的抗肿瘤活性，并且可以使很大比例的患者进行根治性手术。
