Department of Radiation Oncology, Hospital Universitario Sanchinarro, Madrid, Spain,
Strahlenther Onkol. 2014 Jun;190(6):515-20. doi: 10.1007/s00066-014-0650-0. Epub 2014 Apr 9.
To analyze the efficacy and safety of a new preoperative intensity-modulated radiotherapy (IMRT) and integrated-boost chemoradiation scheme.
In all, 74 patients were treated with IMRT and concurrent standard dose capecitabine. The dose of the planning target volume (PTV) encompassing the tumor, mesorectum, and pelvic lymph nodes was 46 Gy in 23 fractions; the boost PTV, at a dose of 57.5 Gy in 23 fractions, included the macroscopic primary tumor and pathological lymph nodes. The patients underwent surgery 6-8 weeks after chemoradiation.
The complete treatment data of 72 patients were analyzed. Tumor downstaging was achieved in 55 patients (76.38 %) and node downstaging in 34 (47.2 %). In 22 patients (30.6 %), there was complete pathological response (ypCR). The circumferential resection margin was free of tumor in 70 patients (97.2 %). The 3-year estimated overall survival and disease-free survival rates were 95.4 and 85.9 % respectively, and no local relapse was found; however, ten patients (13.8 %) developed distant metastases. High pathologic tumor (pT) downstaging was shown as a favorable prognostic factor for disease-free survival. No grade 4 acute radiotherapy-related toxicity was found.
The IMRT and integrated-boost chemoradiation scheme offered higher rates of ypCR and pT downstaging, without a significant increase in toxicity. The circumferential margins were free of tumors in the majority of patients. Primary tumor regression was associated with better disease-free survival.
分析一种新的术前强度调制放疗（IMRT）和综合增敏放化疗方案的疗效和安全性。
共有 74 例患者接受了 IMRT 和同步标准剂量卡培他滨治疗。包含肿瘤、直肠系膜和盆腔淋巴结的计划靶区（PTV）的剂量为 46 Gy/23 次；剂量为 57.5 Gy/23 次的加量 PTV 包括大体原发肿瘤和病理淋巴结。患者在放化疗后 6-8 周进行手术。
对 72 例患者的完整治疗数据进行了分析。55 例（76.38%）患者肿瘤降期，34 例（47.2%）患者淋巴结降期。22 例（30.6%）患者出现完全病理缓解（ypCR）。70 例（97.2%）患者的环周切缘无肿瘤。3 年总生存率和无病生存率分别为 95.4%和 85.9%，未发现局部复发，但有 10 例（13.8%）患者发生远处转移。高病理肿瘤（pT）降期是无病生存的有利预后因素。未发现 4 级急性放疗相关毒性。
IMRT 和综合增敏放化疗方案提供了更高的 ypCR 和 pT 降期率，而毒性没有显著增加。大多数患者的环周切缘无肿瘤。原发肿瘤退缩与更好的无病生存相关。
