术后同步放化疗联合术中电子束放疗对局部晚期直肠癌切除术后的加强治疗：聚焦于局部区域复发地形学模式的长期结果
Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: long-term results focused on topographic pattern of locoregional relapse.
作者信息
Sole Claudio V, Calvo Felipe A, Serrano Javier, Del Valle Emilio, Rodriguez Marcos, Muñoz-Calero Alberto, Turégano Fernando, García-Sabrido Jose Luis, Garcia-Alfonso Pilar, Peligros Isabel, Rivera Sofia, Deutsch Eric, Alvarez Emilio
机构信息
Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
出版信息
Radiother Oncol. 2014 Jul;112(1):52-8. doi: 10.1016/j.radonc.2014.05.012. Epub 2014 Jul 2.
BACKGROUND
Patients with locally advanced rectal cancer (LARC) have a dismal prognosis. We investigated outcomes and risk factors for locoregional recurrence (LRR) in patients treated with preoperative chemoradiotherapy (CRT), surgery and IOERT.
METHODS
A total of 335 patients with LARC [⩾cT3 93% and/or cN+ 69%) were studied. In multivariate analyses, risk factors for LRR, IFLR and OFLR were assessed.
RESULTS
Median follow-up was 72.6 months (range, 4-205). In multivariate analysis distal margin distance ⩽10 mm [HR 2.46, p = 0.03], R1 resection [HR 5.06, p = 0.02], tumor regression grade 1-2 [HR 2.63, p = 0.05] and tumor grade 3 [HR 7.79, p < 0.001] were associated with an increased risk of LRR. A risk model was generated to determine a prognostic index for individual patients with LARC.
CONCLUSIONS
Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRR has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.
背景
局部晚期直肠癌（LARC）患者预后不佳。我们研究了接受术前放化疗（CRT）、手术和术中电子线放疗（IOERT）治疗的患者局部区域复发（LRR）的结局和危险因素。
方法
共研究了335例LARC患者[≥cT3 93%和/或cN+ 69%]。在多变量分析中，评估了LRR、肠壁内复发（IFLR）和肠壁外复发（OFLR）的危险因素。
结果
中位随访时间为72.6个月（范围4 - 205个月）。在多变量分析中，远端切缘距离≤10 mm [风险比（HR）2.46，p = 0.03]、R1切除[HR 5.06，p = 0.02]、肿瘤退缩分级1 - 2级[HR 2.63，p = 0.05]和肿瘤分级3级[HR 7.79，p < 0.001]与LRR风险增加相关。生成了一个风险模型以确定个体LARC患者的预后指数。
结论
LARC多模式治疗后的总体结果令人鼓舞。LRR危险因素的分类有助于提出一个预后指数，使我们能够指导风险适应性个体化治疗。
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