Krajcovicova I, Bolješíková E, Sandorova M, Zavodska A, Zemanová M, Chorváth M, Ondruš D
1st Department of Oncology, Comenius University, Bratislava, Slovak Republic.
Klin Onkol. 2012;25(5):364-9.
Preoperative radiotherapy is considered to be standard treatment for locally advanced rectal cancer. The timing and dosage of radiotherapy with or without preoperative chemotherapy remain controversial issues. The objective of this study was to evaluate relevant clinical outcomes of two preoperative radiotherapy regimens - the short-course and -long-course radiotherapy with or without chemotherapy for patients with locally advanced rectal cancer.
151 patients with stage II-III rectal cancer (103 males and 48 females) treated with preoperative radiotherapy between 01/1999 and 01/2008 were involved in this study. Analysed patterns included sphincter preservation, tumor down-staging, pathological complete remission, frequency of local recurrence, acute and late toxicity, peri-operative complications, overall survival and disease-free survival.
Tumor downstaging has been achieved by long-course radiotherapy alone (46%) or in combination with chemotherapy (5-FU or capecitabine, 61%). Pathological complete remission has also been achieved only in the group with long-course radiotherapy (13%). Long-course radiotherapy combined with chemotherapy significantly decreased post treatment local recurrence rates (5% versus 15% in the group after long-course radiotherapy alone, p = 0.0132). Statistically significant difference was confirmed in overall survival of patients treated with long-course radiotherapy combined with chemotherapy vs long-course radiotherapy alone (p = 0.015). Significant difference between the rate of perioperative complications, of acute and late toxicity, 3 and 5 years disease-free survival of treated patients after short-course radiotherapy and long-course radiotherapy was not confirmed.
Our findings provide convincing evidence that in comparison to preoperative short-course radiotherapy, the preoperative long-course radiotherapy in combination with chemotherapy is the most effective treatment modality for patients with operable locally advanced rectal cancer in terms downstaging and pathologic complete response. Increase in overall survival time as well as lower local recurrence rate makes this modality superior to other preoperative radiotherapy alternatives.
术前放疗被认为是局部晚期直肠癌的标准治疗方法。放疗的时机和剂量，以及是否联合术前化疗，仍然存在争议。本研究的目的是评估两种术前放疗方案——短程和长程放疗联合或不联合化疗——对局部晚期直肠癌患者的相关临床结局。
本研究纳入了1999年1月至2008年1月期间接受术前放疗的151例II-III期直肠癌患者（男性103例，女性48例）。分析的模式包括括约肌保留、肿瘤降期、病理完全缓解、局部复发频率、急性和晚期毒性、围手术期并发症、总生存期和无病生存期。
单纯长程放疗（46%）或联合化疗（5-氟尿嘧啶或卡培他滨，61%）均可实现肿瘤降期。仅在长程放疗组实现了病理完全缓解（13%）。长程放疗联合化疗显著降低了治疗后的局部复发率（长程放疗联合化疗组为5%，单纯长程放疗组为15%，p = 0.0132）。长程放疗联合化疗与单纯长程放疗患者的总生存期经统计学分析有显著差异（p = 0.015）。短程放疗和长程放疗患者的围手术期并发症发生率、急性和晚期毒性、3年和5年无病生存期之间未证实有显著差异。
我们的研究结果提供了令人信服的证据，即与术前短程放疗相比，术前长程放疗联合化疗在肿瘤降期和病理完全缓解方面是可手术的局部晚期直肠癌患者最有效的治疗方式。总生存时间的延长以及局部复发率的降低使这种治疗方式优于其他术前放疗方案。
