Beppu Naohito, Matsubara Nagahide, Kakuno Ayako, Doi Hiroshi, Kamikonya Norihiko, Yamanaka Naoki, Yanagi Hidenori, Tomita Naohiro
1 Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan 2 Department of Pathology, Meiwa Hospital, Nishinomiya, Hyogo, Japan 3 Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan 4 Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan.
Dis Colon Rectum. 2015 May;58(5):479-87. doi: 10.1097/DCR.0000000000000323.
5-Fluorouracil-based chemotherapy is considered to be a radiosensitizer; however, conventional short-course radiotherapy combined with chemotherapy is generally thought to not be feasible because of the prevalence of side effects.
The aim of this study was to evaluate the feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer.
This study was retrospective in nature and used a prospectively collected database.
Patients with T3 rectal cancer located below the peritoneum reflection were selected.
A total dose of 25 Gy of radiotherapy was administered in 10 fractions of 2.5 Gy each for 5 days. Radiotherapy was performed with S-1 as a radiosensitizer from day 1 to day 10. Surgery was targeted to be performed 4 weeks after radiotherapy.
The morbidity, sphincter-preserving rate, anal function, and long-term outcomes were assessed.
All patients (n = 170) completed the radiotherapy regimen and 166 (97.6%) completed the combination regimen with chemotherapy. A total of 149 patients (87.6%) had sphincter-preserving surgery (double stapling technique (DST), 58 patients; intersphincteric resection (ISR), 91 patients), and postoperative complications were relatively mild (anastomotic leakage, 15.4%; intra-abdominal infection, 8.2%). Among those undergoing sphincter preserving surgery, the 5-year local relapse-free survival rate was 94.3% in the DST group, and 89.8% in the ISR group. With respect to the anal function, the Wexner score the first year after stoma closure for the double-stapling technique group was 6 and that for intersphincteric resection was 15; however, the score for the intersphincteric resection group was improved to 8 at 4 years after stoma closure.
This study had limitations because it was an uncontrolled, 1-arm, retrospective review with a small sample size.
Modified short-course radiotherapy combined with chemoradiosensitizer is a feasible approach for treating T3 rectal cancer. With the use of the short-course approach, efforts to reduce the incidence of side effects by appropriately prolonging the waiting period enable the administration of combination treatment with short-course radiotherapy and chemotherapy.
基于5-氟尿嘧啶的化疗被认为是一种放射增敏剂；然而，由于副作用普遍存在，传统的短程放疗联合化疗通常被认为不可行。
本研究旨在评估改良短程放疗联合化学放射增敏剂治疗T3期直肠癌的可行性。
本研究本质上是回顾性的，使用了前瞻性收集的数据库。
选择腹膜反折以下的T3期直肠癌患者。
总共给予25 Gy的放疗，分10次，每次2.5 Gy，共5天。从第1天到第10天，以S-1作为放射增敏剂进行放疗。放疗后4周目标进行手术。
评估发病率、保肛率、肛门功能和长期结局。
所有患者（n = 170）完成了放疗方案，166例（97.6%）完成了化疗联合方案。共有149例患者（87.6%）接受了保肛手术（双吻合器技术（DST），58例；括约肌间切除术（ISR），91例），术后并发症相对较轻（吻合口漏，15.4%；腹腔内感染，8.2%）。在接受保肛手术的患者中，DST组5年局部无复发生存率为94.3%，ISR组为89.8%。关于肛门功能，双吻合器技术组造口关闭后第1年的Wexner评分为6分，括约肌间切除组为15分；然而，括约肌间切除组在造口关闭后4年时评分改善至8分。
本研究存在局限性，因为它是一项无对照、单臂、回顾性研究，样本量较小。
改良短程放疗联合化学放射增敏剂是治疗T3期直肠癌的一种可行方法。采用短程方法，通过适当延长等待期来努力降低副作用发生率，使得短程放疗和化疗联合治疗得以实施。
