Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Republic of Korea.
Jpn J Clin Oncol. 2010 Aug;40(8):754-60. doi: 10.1093/jjco/hyq062. Epub 2010 May 10.
To investigate the long-term outcomes of selected patients with cT3 distal rectal cancer treated with local excision following pre-operative chemoradiotherapy.
Between January 2003 and February 2008, 11 patients with cT3 distal rectal cancer received a local excision following pre-operative chemoradiotherapy. The median age of the patients was 61 years (range, 42-71). The median tumor size was 3 cm (range, 2-5), and the median distance of the caudal tumor edge from the anal verge was 3 cm (range, 1-4). Clinical lymph node status was positive in five patients. Pre-operative chemoradiotherapy consisted of a 50.4 Gy in 28 fractions with concurrent chemotherapy. A transanal full-thickness local excision was performed after a median of 54 days (range, 31-90) from chemoradiotherapy completion. Ten patients received post-operative chemotherapy.
Pathologically complete responses occurred in eight patients, ypT1 in two and ypT2 in one. The pathologic tumor size for three ypT1-2 tumors was 0.9, 1.1 and 2.2 cm. The follow-up period was a median of 59 months (range, 24-85). One patient (ypT0) developed recurrence at the excision site 14 months after surgery, but was successfully salvaged with an abdominoperineal resection and adjuvant chemotherapy. Another patient (ypT2) developed bone metastasis after 8 months and died of the disease. The 5-year local recurrence-free, disease-free and overall survival rates were 90.9%, 81.8% and 88.9%, respectively. No Grade 3 or worse gastrointestinal toxicity was detected.
Full-thickness local excision following chemoradiotherapy may be an acceptable option for cT3 distal rectal cancer that responds well to chemoradiotherapy.
探讨经术前放化疗后行局部切除术治疗 cT3 低位直肠癌患者的长期疗效。
2003 年 1 月至 2008 年 2 月，11 例 cT3 低位直肠癌患者接受了术前放化疗后的局部切除术。患者的中位年龄为 61 岁（范围 42-71 岁）。肿瘤大小的中位数为 3cm（范围 2-5cm），尾侧肿瘤边缘距肛门缘的中位数为 3cm（范围 1-4cm）。5 例患者临床淋巴结阳性。术前放化疗采用 50.4Gy/28f 并同期化疗。距放化疗完成中位时间 54 天（范围 31-90 天）后行经肛门全层局部切除术。10 例患者接受了术后化疗。
8 例患者病理完全缓解，ypT1 2 例，ypT2 1 例。3 例 ypT1-2 肿瘤的病理肿瘤大小分别为 0.9、1.1 和 2.2cm。中位随访时间为 59 个月（范围 24-85 个月）。1 例（ypT0）患者在术后 14 个月时于切除部位复发，但通过腹会阴切除术和辅助化疗成功挽救。另 1 例（ypT2）患者在 8 个月后发生骨转移，死于该疾病。5 年局部无复发生存率、无疾病生存率和总生存率分别为 90.9%、81.8%和 88.9%。未检测到 3 级或更高级别的胃肠道毒性。
对于对放化疗反应良好的 cT3 低位直肠癌，全层局部切除可能是一种可接受的选择。
