You Yau-Tong, Chen Jinn-Shiun, Wang Jeng-Yi, Tang Reiping, Changchien Chung-Rong, Chiang Jy-Ming, Yeh Chien-Yuh, Hsieh Pao-Shiu, Tasi Wen-Sy, Hung Hsin-Yuan, You Jeng-Fu, Chiang Sum-Fu
Division of Colon and Rectal Surgery, Chang Gung University College of Medicine, Taiwan.
Hepatogastroenterology. 2013 Jan-Feb;60(121):94-8. doi: 10.5754/hge12503.
BACKGROUND/AIMS: Long course concurrent chemoradiotherapy provides potential tumor downstaging. When local recurrent rectal cancer without distant metastases is diagnosed, a potentially curative resection can be performed. The aim of this study was to assess the outcome of concurrent chemoradiotherapy in treating isolated local recurrent rectal cancer.
Patients (n=102) with isolated local recurrent rectal cancer within the pelvis were scheduled for concurrent chemoradiotherapy, consisting of pelvic irradiation with a total dose of 50.4 Gy in 28 fractions. Chemotherapy was administered concurrently and included 85 mg/m2 oxaliplatin by venous infusion over 2 h on day 1, followed by 1,200 mgm-2day-1 of continuous venous infusion for 2 days. This regimen was repeated every 2 weeks for 6 cycles. The overall survival rate, responses, disease-free interval and toxicities were assessed.
A total of 96 patients completed planned concurrent chemoradiation. Complete clinical responses were found in 13 of the 96 patients (14%), partial responses in 59 (61%), stable disease in 21 (22%) and disease progression in 3 (3%). The overall survival and disease-free survival rates in all the 96 patients were 45% and 14%, respectively.
The treatment of locally recurrent rectal cancer is complicated. Concurrent chemoradiation can increase disease-free survival and overall survival by increasing complete resection rate of locally recurrent tumors and even complete response of the tumors. Ongoing treatment strategies aim to enhance response rates and to accurately assess the extent of local recurrent tumor response to concurrent chemoradiation.
背景/目的：长疗程同步放化疗具有潜在的肿瘤降期作用。当诊断为无远处转移的局部复发性直肠癌时，可进行有可能治愈的切除术。本研究的目的是评估同步放化疗治疗孤立性局部复发性直肠癌的疗效。
计划对102例盆腔内孤立性局部复发性直肠癌患者进行同步放化疗，包括盆腔照射，总剂量50.4 Gy，分28次进行。同步给予化疗，具体方案为第1天静脉输注85 mg/m²奥沙利铂，持续2小时，随后连续2天静脉输注1200 mg·m⁻²·天⁻¹。每2周重复该方案，共6个周期。评估总生存率、反应情况、无病间期和毒性反应。
共有96例患者完成了计划的同步放化疗。96例患者中，13例（14%）达到完全临床缓解，59例（61%）部分缓解，21例（22%）病情稳定，3例（3%）病情进展。96例患者的总生存率和无病生存率分别为45%和14%。
局部复发性直肠癌的治疗较为复杂。同步放化疗可通过提高局部复发性肿瘤的完全切除率甚至肿瘤的完全缓解率来提高无病生存率和总生存率。正在进行的治疗策略旨在提高反应率，并准确评估局部复发性肿瘤对同步放化疗的反应程度。
