Feng Yan-Ru, Jin Jing, Ren Hua, Wang Xin, Wang Shu-Lian, Wang Wei-Hu, Song Yong-Wen, Liu Yue-Ping, Tang Yuan, Li Ning, Liu Xin-Fan, Fang Hui, Yu Zi-Hao, Li Ye-Xiong
Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, China.
BMC Cancer. 2017 Mar 9;17(1):182. doi: 10.1186/s12885-017-3170-3.
In this era of oxaliplatin-based adjuvant therapy, the optimal sequence in which chemoradiotherapy should be administered for pathological stage N2 rectal cancer is unknown. The aim of this study was to investigate this sequence.
In the primary adjuvant concurrent chemoradiotherapy (A-CRT) group (n = 71), postoperative concurrent chemoradiotherapy was administered before adjuvant chemotherapy. In the primary adjuvant chemotherapy (A-CT) group (n = 43), postoperative concurrent chemoradiotherapy was administered during or after adjuvant chemotherapy. Postoperative radiotherapy comprised 45-50.4 Gy in 25-28 fractions. Concurrent chemotherapy comprised two cycles of oral capecitabine (1,600 mg/m) on days 1-14 and 22-35. Patients receiving adjuvant chemotherapy with four or more cycles of XELOX (oxaliplatin plus capecitabine) or eight or more cycles of FOLFOX (fluorouracil, leucovorin, and oxaliplatin) were included.
Between June 2005 and December 2013, data for 114 qualified rectal cancer patients were analyzed. The percentages of patients in whom treatment failed in the A-CRT and A-CT groups were 33.8% and 16.3%, respectively (p = 0.042). More patients had distant metastases in the A-CRT group than in the A-CT group (32.4% vs. 14.3%, p = 0.028). Multivariate analysis indicated that the sequence in which chemoradiotherapy was administered (A-CT vs. A-CRT) was an independent prognostic factor for both estimated disease-free survival [hazard ratio (HR) 0.345, 95% confidence interval (CI) 0.137-0.868, p = 0.024] and estimated distant metastasis-free survival (HR 0.366, 95% CI 0.143-0.938, p = 0.036).
In pathological stage N2 rectal cancer patients, administering adjuvant chemotherapy before chemoradiotherapy led to a lower rate of treatment failure, especially with respect to distant metastasis. Adjuvant chemotherapy prescribed as early as possible might benefit this cohort of patients in this era of oxaliplatin-based adjuvant therapy.
在这个以奥沙利铂为基础的辅助治疗时代，对于病理分期为N2的直肠癌患者，放化疗的最佳给药顺序尚不清楚。本研究的目的是探究这一给药顺序。
在主要辅助同步放化疗（A-CRT）组（n = 71）中，术后同步放化疗在辅助化疗之前进行。在主要辅助化疗（A-CT）组（n = 43）中，术后同步放化疗在辅助化疗期间或之后进行。术后放疗包括25 - 28次分割，剂量为45 - 50.4 Gy。同步化疗包括在第1 - 14天和第22 - 35天口服两周期卡培他滨（1600 mg/m²）。纳入接受四个或更多周期XELOX（奥沙利铂加卡培他滨）或八个或更多周期FOLFOX（氟尿嘧啶、亚叶酸钙和奥沙利铂）辅助化疗的患者。
2005年6月至2013年12月期间，对114例符合条件的直肠癌患者的数据进行了分析。A-CRT组和A-CT组治疗失败患者的百分比分别为33.8%和16.3%（p = 0.042）。A-CRT组发生远处转移的患者比A-CT组更多（32.4%对14.3%，p = 0.028）。多因素分析表明，放化疗的给药顺序（A-CT与A-CRT）是估计无病生存期[风险比（HR）0.345，95%置信区间（CI）0.137 - 0.868，p = 0.024]和估计无远处转移生存期（HR 0.366，95% CI 0.143 - 0.938，p = 0.036）的独立预后因素。
在病理分期为N2的直肠癌患者中，在放化疗之前进行辅助化疗导致治疗失败率较低，尤其是在远处转移方面。在这个以奥沙利铂为基础的辅助治疗时代，尽早给予辅助化疗可能使这组患者受益。
