Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Radiat Oncol. 2010 Aug 31;5:75. doi: 10.1186/1748-717X-5-75.
Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. The rates of local failure and distant metastasis are substantial in these patients, even after undergoing aggressive treatments including resection of primary and metastatic liver tumors. The purpose of this study was to determine whether adjuvant pelvic radiotherapy is beneficial for pelvic control and overall survival in rectal cancer patients with synchronous liver metastasis after primary tumor resection.
Among rectal cancer patients who received total mesorectal excision (TME) between 1997 and 2006 at Yonsei University Health System, eighty-nine patients diagnosed with synchronous liver metastasis were reviewed. Twenty-seven patients received adjuvant pelvic RT (group S + R), and sixty-two patients were managed without RT (group S). Thirty-six patients (58%) in group S and twenty patients (74%) in group S+R received local treatment for liver metastasis. Failure patterns and survival outcomes were analyzed.
Pelvic failure was observed in twenty-five patients; twenty-one patients in group S (34%), and four patients in group S+R (15%) (p = 0.066). The two-year pelvic failure-free survival rates (PFFS) of group S and group S+R were 64.8% and 80.8% (p = 0.028), respectively, and the two-year overall survival rates (OS) were 49.1% and 70.4% (p = 0.116), respectively. In a subgroup analysis of fifty-six patients who received local treatment for liver metastasis, the two-year PFFS were 64.9% and 82.9% (p = 0.05), respectively; the two-year OS were 74.1% and 80.0% (p = 0.616) in group S (n = 36) and group S+R (n = 20), respectively.
Adjuvant pelvic RT significantly reduced the pelvic failure rate but its influence on overall survival was unclear. Rectal cancer patients with synchronous liver metastasis may benefit from adjuvant pelvic RT through an increased pelvic control rate and improved quality of life.
约 25%的结直肠癌患者在确诊时会出现同步肝转移。即使接受了包括原发和肝转移瘤切除在内的积极治疗，这些患者仍存在较高的局部失败和远处转移率。本研究旨在确定在接受全直肠系膜切除术（TME）治疗的结直肠癌患者中，辅助盆腔放疗是否有益于原发肿瘤切除后合并同步肝转移患者的盆腔控制和总生存。
在延世大学健康系统 1997 年至 2006 年间接受 TME 的直肠癌患者中，对 89 例诊断为同步肝转移的患者进行了回顾性分析。其中 27 例患者接受了辅助盆腔放疗（S+R 组），62 例患者未接受放疗（S 组）。S 组中 36 例（58%）和 S+R 组中 20 例（74%）患者接受了肝转移的局部治疗。分析失败模式和生存结果。
25 例患者出现盆腔失败，S 组 21 例（34%），S+R 组 4 例（15%）（p=0.066）。S 组和 S+R 组的 2 年盆腔无失败生存率（PFFS）分别为 64.8%和 80.8%（p=0.028），2 年总生存率（OS）分别为 49.1%和 70.4%（p=0.116）。在对 56 例接受肝转移局部治疗的患者进行亚组分析中，2 年 PFFS 分别为 64.9%和 82.9%（p=0.05），S 组（n=36）和 S+R 组（n=20）的 2 年 OS 分别为 74.1%和 80.0%（p=0.616）。
辅助盆腔放疗显著降低了盆腔失败率，但对总生存的影响尚不清楚。合并同步肝转移的直肠癌患者可能受益于辅助盆腔放疗，因为它提高了盆腔控制率和改善了生活质量。
