Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Cancer. 2013 Oct;49(15):3131-9. doi: 10.1016/j.ejca.2013.05.025. Epub 2013 Jun 22.
Pre-operative radiotherapy has proven to reduce local recurrences after curative surgery for rectal cancer. Radiotherapy is generally well tolerated, although postoperative morbidity and mortality was increased in some patients. Current study was undertaken to analyse whether the interval between preoperative radiotherapy and surgery influences post-operative mortality and recurrence for two cohorts.
All Dutch patients included in the total mesorectal excision (TME)-trial receiving radiotherapy for resectable rectal cancer were included in this study (n=642). The verification set consisted of all patients receiving short-course radiotherapy for resectable rectal cancer in two radiotherapy clinics in The Netherlands (n=600). Univariate and multivariable survival analyses for overall survival, disease-free survival, local recurrence-free survival and non-cancer related survival were calculated.
Patients aged 75 years and older treated during the TME-trial showed a worse overall and non-cancer-related survival when surgically treated 4-7 days after the last fraction of radiotherapy. No differences in survival between the interval groups were found in the verification set.
Present study found that elderly patients aged 75 years and older operated 4-7 days after the last fraction of radiotherapy had a higher chance of dying due to non-cancer-related causes during the TME-trial as compared to patients with an interval of 0-3 days. In the verification set similar differences could not be confirmed, which could be due to awareness of the clinicians who avoided delayed surgery after radiotherapy since the results have been presented during congresses. A longer than recommended interval between radiotherapy and surgery should be avoided. Besides, the verification set suggests that radiotherapy duration of 7 days is acceptable.
术前放疗已被证明可降低直肠癌根治术后的局部复发率。放疗通常耐受性良好，但某些患者的术后发病率和死亡率会增加。本研究旨在分析术前放疗与手术之间的间隔时间是否会影响两个队列的术后死亡率和复发率。
本研究纳入了所有在荷兰接受全直肠系膜切除术（TME）试验并接受放疗的可切除直肠癌患者（n=642）。验证集包括荷兰两家放疗诊所接受短程放疗的所有可切除直肠癌患者（n=600）。对总生存期、无病生存期、局部无复发生存期和非癌症相关生存期进行了单变量和多变量生存分析。
TME 试验中年龄在 75 岁及以上的患者在接受最后一次放疗的 4-7 天后接受手术治疗时，总生存期和非癌症相关生存期较差。在验证集中，各组间的生存差异无统计学意义。
本研究发现，与间隔时间为 0-3 天的患者相比，TME 试验中年龄在 75 岁及以上的老年患者在最后一次放疗后 4-7 天接受手术治疗时，因非癌症相关原因死亡的风险更高。验证集无法证实类似的差异，这可能是由于临床医生在会议上展示结果后避免了放疗后延迟手术。应避免放疗与手术之间的间隔时间长于推荐时间。此外，验证集表明 7 天的放疗时间是可以接受的。
