Cukier M, Smith A J, Milot L, Chu W, Chung H, Fenech D, Herschorn S, Ko Y, Rowsell C, Soliman H, Ung Y C, Wong C S
Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Eur J Surg Oncol. 2012 Aug;38(8):677-82. doi: 10.1016/j.ejso.2012.05.001. Epub 2012 May 24.
Although there is an extensive body of literature on the role of neoadjuvant chemoradiotherapy (CRT) in the management of rectal cancer, its role in primary locally advanced adherent colon cancer (LAACC) is unclear.
To analyzed the outcomes of neoadjuvant CRT and multivisceral resection in the management of LAACC patietns.
We retrospectively reviewed our institutional Colorectal Carcinoma Database for 33 patients with potentially resectable, non-metastatic primary LAACC who received neoadjuvant CRT followed by multivisceral resection. CRT consisted of external beam radiation (45-50 Gy in 25 daily fractions) and concurrent 5-FU infusion (225 mg/m(2)/day).
There were 21 males and 12 females. Median age was 64 (31-83) and median follow-up was 36 months. All patients had microscopically clear resection margins (R0). Complete pathologic response was documented in 1 patient (3%) and 66% had ypT4b disease. Post-operative complications were observed in 36% of patients with no 30-day mortality. The 3-year overall survival and 3-year disease-free survival were 85.9% and 73.7% respectively. Two patients developed a local recurrence.
Neoadjuvant CRT and en-bloc multivisceral resection may result in high rates of R0 resection and excellent local control with acceptable morbidity and mortality in selected patients with LAACC.
尽管有大量关于新辅助放化疗（CRT）在直肠癌治疗中作用的文献，但其在原发性局部晚期粘连性结肠癌（LAACC）中的作用尚不清楚。
分析新辅助CRT和多脏器切除在LAACC患者治疗中的结果。
我们回顾性分析了我院结直肠癌数据库中33例潜在可切除、非转移性原发性LAACC患者的资料，这些患者接受了新辅助CRT，随后进行了多脏器切除。CRT包括外照射（25次，每次45 - 50 Gy）和同步5 - FU输注（225 mg/m²/天）。
男性21例，女性12例。中位年龄64岁（31 - 83岁），中位随访时间36个月。所有患者显微镜下切缘均为阴性（R0）。1例患者（3%）有完全病理缓解，66%有ypT4b期疾病。36%的患者出现术后并发症，无30天死亡病例。3年总生存率和3年无病生存率分别为85.9%和73.7%。2例患者出现局部复发。
对于部分LAACC患者，新辅助CRT和整块多脏器切除可能导致高R0切除率和良好的局部控制，且发病率和死亡率可接受。
