Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
BMC Cancer. 2012 Dec 11;12:592. doi: 10.1186/1471-2407-12-592.
To evaluate disease control, overall survival and prognostic factors in patients with locally recurrent rectal cancer after IOERT-containing multimodal therapy.
Between 1991 and 2006, 97 patients with locally recurrent rectal cancer have been treated with surgery and IOERT. IOERT was preceded or followed by external beam radiation therapy (EBRT) in 54 previously untreated patients (median dose 41.4 Gy) usually combined with 5-Fluouracil-based chemotherapy (89%). IOERT was delivered via cylindric cones with doses of 10-20 Gy. Adjuvant CHT was given only in a minority of patients (34%). Median follow-up was 51 months.
Margin status was R0 in 37%, R1 in 33% and R2 in 30% of the patients. Neoadjuvant EBRT resulted in significantly increased rates of free margins (52% vs. 24%). Median overall survival was 39 months. Estimated 5-year rates for central control (inside the IOERT area), local control (inside the pelvis), distant control and overall survival were 54%, 41%, 40% and 30%. Resection margin was the strongest prognostic factor for overall survival (3-year OS of 80% (R0), 37% (R1), 35% (R2)) and LC (3-year LC 82% (R0), 41% (R1), 18% (R2)) in the multivariate model. OS was further significantly affected by clinical stage at first diagnosis and achievement of local control after treatment in the univariate model. Distant failures were found in 46 patients, predominantly in the lung. 90-day postoperative mortality was 3.1%.
Long term OS and LC can be achieved in a substantial proportion of patients with recurrent rectal cancer using a multimodality IOERT-containing approach, especially in case of clear margins. LC and OS remain limited in patients with incomplete resection. Preoperative re-irradiation and adjuvant chemotherapy may be considered to improve outcome.
评估局部复发性直肠癌患者在接受 IOERT 为基础的多模态治疗后的疾病控制、总生存率和预后因素。
1991 年至 2006 年期间，97 例局部复发性直肠癌患者接受了手术和 IOERT 治疗。在 54 例未经治疗的患者中，IOERT 先于或后于外部束放射治疗（EBRT）进行（中位剂量 41.4 Gy），通常与基于 5-氟尿嘧啶的化疗（89%）联合使用。IOERT 通过剂量为 10-20 Gy 的圆柱状射束进行。辅助 CHT 仅在少数患者中使用（34%）。中位随访时间为 51 个月。
患者的切缘状态为 R0 占 37%，R1 占 33%，R2 占 30%。新辅助 EBRT 显著提高了无切缘（52%比 24%）。中位总生存率为 39 个月。中央控制（IOERT 区域内）、局部控制（骨盆内）、远处控制和总生存率的估计 5 年率分别为 54%、41%、40%和 30%。切除边缘是总生存率（3 年 OS 为 80%（R0）、37%（R1）、35%（R2））和局部控制（3 年 LC 为 82%（R0）、41%（R1）、18%（R2））的最强预后因素在多变量模型中。在单变量模型中，OS 进一步受到首次诊断时临床分期和治疗后局部控制的显著影响。远处失败发生在 46 例患者中，主要在肺部。术后 90 天死亡率为 3.1%。
在局部复发性直肠癌患者中，使用包含 IOERT 的多模态方法可实现长期总生存率和局部控制率，尤其是在切缘清晰的情况下。在不完全切除的患者中，LC 和 OS 仍然有限。术前再照射和辅助化疗可能被认为是改善预后的方法。
