BMC Cancer. 2013 Aug 16;13:388. doi: 10.1186/1471-2407-13-388.
Neoadjuvant radiochemotherapy has been proven superior to adjuvant treatment in reducing the rate of local recurrence without impairing cancer related survival or the incidence of distant metastases in standard protocols of neoadjuvant radiochemotherapy. The present study aimed at addressing the effects of an intensified neoadjuvant radiochemotherapy on long term cancer related and disease free survival.
A total of 387 patients underwent oncologic resection for rectal cancer in our institution between January 2000 and December 2009. There were 106 patients (27.4%) who received an intensified radiochemotherapy protocol completely and without excluding criteria (study group). A matched pair analysis was performed by comparing the study group with patients undergoing primary surgery and postoperative radiochemotherapy, if necessary and possible (control group). Matching was carried out in descending order for UICC stage, R-status, tumor height, T-, N-, V-, L-, M- and G-category of the TNM-system according to the histopathological staging. Follow-up data included local recurrence rate, cancer related and disease free survival.
In the study group histopathological work-up of the specimen revealed a treatment response in terms of tumor regression in 92.5% (98/106) of these patients. Undergoing intensified neoadjuvant RCT the actuarial cancer related and disease free survival was 67.9% and 70.4%, local recurrence was 5.7% after an observation period of 4.3 ± 2.55 years. In the control group cancer related and disease free survival was 71.7% and 82.7%, local recurrence was 4.7% after an observation period of 3.8 ± 3.05 years revealing no statistical significant difference between the two groups. Moreover, estimated 5-year results of cancer related survival (66.7% vs 67.9% (controls)), the disease free survival (66.7% vs 79.9% (controls)) as well as subgroup analysis of UICC 0-III and UICC IV patients showed no difference between the study and control group as well.
In our study, intensified neoadjuvant radio-chemotherapy shows a high rate of tumor regression. The resulting inferior histopathological tumor stage shows the same long term local control and systemic tumor control as the control group with a primary more favorable tumor stage.
新辅助放化疗已被证明可降低局部复发率，而不会影响癌症相关生存率或远处转移率，优于辅助治疗。在新辅助放化疗的标准方案中。本研究旨在探讨强化新辅助放化疗对长期癌症相关和无病生存的影响。
2000 年 1 月至 2009 年 12 月，我院共对 387 例直肠癌患者进行了肿瘤切除术。有 106 例（27.4%）患者接受了完全强化放化疗方案，无排除标准（研究组）。通过比较研究组与接受原发性手术和术后放化疗的患者（对照组），采用配对分析。匹配按 UICC 分期、R 状态、肿瘤高度、T、N、V、L、M 和 TNM 系统的 G 类的降序进行。随访数据包括局部复发率、癌症相关生存率和无病生存率。
在研究组中，对标本的组织学检查显示 92.5%（98/106）的患者有肿瘤消退的治疗反应。在接受强化新辅助 RCT 治疗后，在 4.3±2.55 年的观察期内，癌症相关和无病生存率分别为 67.9%和 70.4%，局部复发率为 5.7%。在对照组中，癌症相关和无病生存率分别为 71.7%和 82.7%，局部复发率为 4.7%，在 3.8±3.05 年的观察期内无统计学差异。此外，癌症相关生存率（66.7%vs67.9%（对照组））、无病生存率（66.7%vs79.9%（对照组））的 5 年估计结果以及 UICC 0-III 和 UICC IV 患者的亚组分析均显示研究组与对照组之间无差异。
在我们的研究中，强化新辅助放化疗显示出较高的肿瘤消退率。由此产生的组织学肿瘤分期较低表明，与具有原发更有利肿瘤分期的对照组相比，具有相同的长期局部控制和全身肿瘤控制。
