Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Radiother Oncol. 2017 Apr;123(1):147-153. doi: 10.1016/j.radonc.2017.02.009. Epub 2017 Mar 10.
Preoperative therapy reduces local recurrences and may facilitate surgery in rectal cancer patients. However, in patients with inflammatory bowel disease (IBD) this treatment is often withheld due to the perceived risk of excessive side-effects, even though evidence is limited. The purpose of this study is to investigate the effects of preoperative therapy on acute toxicity and post-operative complications in IBD patients with rectal cancer.
The Dutch pathology registry (PALGA) was searched for patients with IBD and rectal cancer treated between January 1991 and May 2010. Histopathology and clinical charts were reviewed to confirm IBD diagnosis and evaluate clinical and pathological characteristics.
Out of 161 patients, 66 received preoperative therapy (41%), including short-course radiation therapy (SC-RT), long course radiation therapy (LC-RT), and chemoradiation therapy (CRT) in 32, 13, and 21 patients respectively. Grade≥3 acute toxicity occurred in 0 patients (0.0%), 1 patient (7.7%), and 6 patients (28.6%) respectively (p=0.004). Systemic corticosteroids were used by 10.5% of patients at time of treatment. Grade≥3 post-operative 30-day complication rate (28.1% overall) was not associated with type of preoperative therapy.
Results did not show excessive rates of toxicity or post-operative complications and support the use of standard preoperative therapies for rectal cancer (especially SC-RT) in IBD patients with relatively indolent disease. Caution is warranted in patients with active IBD, since the exact impact of active bowel inflammation could not be determined retrospectively. Prospective studies should investigate the influence of active IBD on acute and late toxicity in patients receiving pelvic irradiation.
术前治疗可降低直肠癌患者的局部复发率，并有助于手术。然而，由于担心副作用过大，炎症性肠病（IBD）患者通常不接受这种治疗，尽管证据有限。本研究旨在探讨术前治疗对 IBD 合并直肠癌患者急性毒性和术后并发症的影响。
在 1991 年 1 月至 2010 年 5 月期间，通过荷兰病理学登记处（PALGA）搜索患有 IBD 和直肠癌的患者。通过回顾组织病理学和临床图表来确认 IBD 诊断，并评估临床和病理特征。
在 161 名患者中，有 66 名（41%）接受了术前治疗，包括短程放疗（SC-RT）、长程放疗（LC-RT）和放化疗（CRT），分别有 32、13 和 21 名患者接受了上述治疗。0 名（0.0%）、1 名（7.7%）和 6 名（28.6%）患者分别出现≥3 级急性毒性（p=0.004）。治疗时，有 10.5%的患者使用了全身皮质类固醇。≥30 天的术后并发症发生率（总体为 28.1%）与术前治疗类型无关。
结果并未显示毒性或术后并发症发生率过高，支持对相对惰性疾病的 IBD 患者使用标准的术前治疗方法（尤其是 SC-RT）。对于活动性 IBD 患者应谨慎，因为无法回顾性确定活动性肠炎症的确切影响。前瞻性研究应调查在接受骨盆照射的患者中，活动性 IBD 对急性和晚期毒性的影响。
