Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Radiat Oncol. 2011 May 20;6:51. doi: 10.1186/1748-717X-6-51.
To assess the clinical outcome of chemoradiotherapy with or without surgery for locally recurrent rectal cancer (LRRC) and to find useful and significant prognostic factors for a clinical situation.
Between January 2001 and February 2009, 67 LRRC patients, who entered into concurrent chemoradiotherapy with or without surgery, were reviewed retrospectively. Of the 67 patients, 45 were treated with chemoradiotherapy plus surgery, and the remaining 22 were treated with chemoradiotherapy alone. The mean radiation doses (biologically equivalent dose in 2-Gy fractions) were 54.6 Gy and 66.5 Gy for the chemoradiotherapy with and without surgery groups, respectively.
The median survival duration of all patients was 59 months. Five-year overall (OS), relapse-free (RFS), locoregional relapse-free (LRFS), and distant metastasis-free survival (DMFS) were 48.9%, 31.6%, 66.4%, and 40.6%, respectively. A multivariate analysis demonstrated that the presence of symptoms was an independent prognostic factor influencing OS, RFS, LRFS, and DMFS. No statistically significant difference was found in OS (p = 0.181), RFS (p = 0.113), LRFS (p = 0.379), or DMFS (p = 0.335) when comparing clinical outcomes between the chemoradiotherapy with and without surgery groups.
Chemoradiotherapy with or without surgery could be a potential option for an LRRC cure, and the symptoms related to LRRC were a significant prognostic factor predicting poor clinical outcome. The chemoradiotherapy scheme for LRRC patients should be adjusted to the possibility of resectability and risk of local failure to focus on local control.
评估局部复发性直肠癌（LRRC）放化疗联合或不联合手术的临床疗效，并寻找对临床情况有意义的预后因素。
回顾性分析 2001 年 1 月至 2009 年 2 月间接受同期放化疗联合或不联合手术治疗的 67 例 LRRC 患者。67 例患者中，45 例接受放化疗联合手术治疗，22 例接受单纯放化疗。放化疗联合手术组和单纯放化疗组的平均放疗剂量（2-Gy 分割的生物等效剂量）分别为 54.6 Gy 和 66.5 Gy。
所有患者的中位生存时间为 59 个月。5 年总生存（OS）、无复发生存（RFS）、局部区域无复发生存（LRFS）和无远处转移生存（DMFS）分别为 48.9%、31.6%、66.4%和 40.6%。多因素分析显示，症状的存在是影响 OS、RFS、LRFS 和 DMFS 的独立预后因素。放化疗联合手术组与单纯放化疗组在 OS（p = 0.181）、RFS（p = 0.113）、LRFS（p = 0.379）或 DMFS（p = 0.335）方面的临床结局比较差异均无统计学意义。
放化疗联合或不联合手术可能是 LRRC 治愈的一种潜在选择，与 LRRC 相关的症状是预测临床结局不良的显著预后因素。LRRC 患者的放化疗方案应根据可切除性和局部失败风险进行调整，以侧重于局部控制。
