Tao Randa, Tsai Chiaojung Jillian, Jensen Garrett, Eng Cathy, Kopetz Scott, Overman Michael J, Skibber John M, Rodriguez-Bigas Miguel, Chang George J, You Yi-Qian Nancy, Bednarski Brian K, Minsky Bruce D, Delclos Marc E, Koay Eugene, Krishnan Sunil, Crane Christopher H, Das Prajnan
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
Radiother Oncol. 2017 Jan;122(1):146-151. doi: 10.1016/j.radonc.2016.12.015. Epub 2017 Jan 3.
To evaluate outcomes and toxicity in patients treated with hyperfractionated pelvic reirradiation for recurrent rectal cancer.
102 patients with recurrent rectal adenocarcinoma were treated with pelvic reirradiation with a hyperfractionated accelerated approach, consisting of 1.5Gy twice daily fractions to a total dose of 30-45Gy (median 39Gy), with the most common total dose 39Gy (n=90, 88%). The median dose of prior pelvic radiation therapy (RT) was 50.4Gy (range: 25-63Gy).
The median follow-up was 40months for living patients (range, 3-150months). The 3-year freedom from local progression (FFLP) rate was 40% and the 3-year overall survival (OS) rate was 39%. Treatment with surgery was significantly associated with improved FFLP and OS, with 3-year FFLP rate of 49% vs. 30% (P=0.013), and 3-year OS rate of 62% vs. 20% (P<0.0001), compared to those without surgery. The actuarial 3-year rate of grade 3-4 late toxicity was 34%; patients who underwent surgery had a significantly higher rate of grade 3-4 late toxicity compared to those without surgery (54% vs. 16%, P=0.001).
This large, retrospective, single-institution study shows that hyperfractionated accelerated reirradiation was well tolerated. The rate of FFLP was promising, given that the study comprised heavily pre-treated patients with recurrences. Rates of FFLP and OS were particularly impressive in patients who underwent both reirradiation and surgery.
评估超分割盆腔再照射治疗复发性直肠癌患者的疗效及毒性。
102例复发性直肠腺癌患者采用超分割加速盆腔再照射治疗，即每天两次，每次1.5Gy，总剂量30 - 45Gy（中位剂量39Gy），最常见的总剂量为39Gy（n = 90，88%）。既往盆腔放疗（RT）的中位剂量为50.4Gy（范围：25 - 63Gy）。
存活患者的中位随访时间为40个月（范围：3 - 150个月）。3年局部无进展生存率（FFLP）为40%，3年总生存率（OS）为39%。手术治疗与FFLP和OS的改善显著相关，与未接受手术的患者相比，3年FFLP率分别为49%和30%（P = 0.013），3年OS率分别为62%和20%（P < 0.0001）。3级至4级晚期毒性的精算3年发生率为34%；接受手术的患者3级至4级晚期毒性发生率显著高于未接受手术的患者（54%对16%，P = 0.001）。
这项大型、回顾性、单中心研究表明，超分割加速再照射耐受性良好。鉴于该研究纳入了大量经过多次治疗的复发患者，FFLP率很有前景。接受再照射和手术的患者的FFLP和OS率尤其令人印象深刻。
