原发性直肠癌的放疗对复发性直肠癌盆腔脏器清除术后的预后有影响吗？

Does radiotherapy of the primary rectal cancer affect prognosis after pelvic exenteration for recurrent rectal cancer?

作者信息

Rombouts Anouk J M, Koh Cherry E, Young Jane M, Masya Lindy, Roberts Rachael, De-Loyde Katie, de Wilt Johannes H W, Solomon Michael J

机构信息

1 Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 2 Surgical Outcomes Research Centre, Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 3 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

出版信息

Dis Colon Rectum. 2015 Jan;58(1):65-73. doi: 10.1097/DCR.0000000000000213.

DOI:10.1097/DCR.0000000000000213

PMID:25489696

Abstract

BACKGROUND

Radiotherapy reduces local recurrence rates but is also capable of short- and long-term toxicity. It may also render treatment of local recurrence more challenging if it develops despite previous radiotherapy.

OBJECTIVE

This study examined the impact of radiotherapy for the primary rectal cancer on outcomes after pelvic exenteration for local recurrence.

DESIGN

We conducted a retrospective review of exenteration databases.

SETTING

The study took place at a quaternary referral center that specializes in pelvic exenteration.

PATIENTS

Patients referred for pelvic exenteration from October 1994 to November 2012 were reviewed. Patients who did and did not receive radiotherapy as part of their primary rectal cancer treatment were compared.

MAIN OUTCOME MEASURES

The main outcomes of interest were resection margins, overall survival, disease-free survival, and surgical morbidities.

RESULTS

There were 108 patients, of which 87 were eligible for analysis. Patients who received radiotherapy for their primary rectal cancer (n = 41) required more radical exenterations (68% vs 44%; p = 0.020), had lower rates of clear resection margins (63% vs 87%; p = 0.010), had increased rates of surgical complications per patient (p = 0.014), and had a lower disease-free survival (p = 0.022). Overall survival and disease-free survival in patients with clear margins were also lower in the primary irradiated patients (p = 0.049 and p < 0.0001). This difference in survival persisted in multivariate analysis that corrected for T and N stages of the primary tumor.

LIMITATIONS

This study is limited by its retrospective nature and heterogeneous radiotherapy regimes among radiotherapy patients.

CONCLUSIONS

Patients who previously received radiotherapy for primary rectal cancer treatment have worse oncologic outcomes than those who had not received radiotherapy after pelvic exenteration for locally recurrent rectal cancer.

摘要

背景

放射治疗可降低局部复发率，但也会产生短期和长期毒性。如果在先前放疗后仍发生局部复发，可能会使局部复发的治疗更具挑战性。

目的

本研究探讨原发性直肠癌放疗对局部复发盆腔脏器清除术后结局的影响。

设计

我们对盆腔脏器清除术数据库进行了回顾性分析。

地点

研究在一家专门进行盆腔脏器清除术的四级转诊中心开展。

患者

对1994年10月至2012年11月转诊进行盆腔脏器清除术的患者进行了回顾。比较了接受和未接受放疗作为原发性直肠癌治疗一部分的患者。

主要观察指标

主要关注的结局指标为切缘、总生存期、无病生存期和手术并发症。

结果

共有108例患者，其中87例符合分析条件。接受原发性直肠癌放疗的患者（n = 41）需要更广泛的盆腔脏器清除术（68%对44%；p = 0.020），切缘阴性率较低（63%对87%；p = 0.010），每位患者的手术并发症发生率增加（p = 0.014），无病生存期较低（p = 0.022）。切缘阴性患者的总生存期和无病生存期在接受原发性放疗的患者中也较低（p = 0.049和p < 0.0001）。在对原发性肿瘤的T和N分期进行校正的多变量分析中，这种生存差异仍然存在。