Engineer Reena, Ostwal Vikas, Arya Supreeta, Gupta Priyamvada, Chopra Supriya, Patil Prachi, Jatal Sudhir, Saklani Avanish
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
Asia Pac J Clin Oncol. 2017 Aug;13(4):322-328. doi: 10.1111/ajco.12660. Epub 2017 Mar 17.
A proportion of locally advanced rectal cancer patients who receive neoadjuvant chemoradiotherapy (NACRT) are still unresectable. This study was undertaken to assess the outcomes of giving additional chemotherapy to rectal cancer patients with unresectable disease after NACRT.
Patients with poor response to NACRT where mesorectal fascia was still involved on MRI and R0 resection was doubtful, received additional four cycles of chemotherapy with either CAPOX or FOLFIRINOX regimen, and the response was reevaluated with MRI and reassessed for surgical resection.
Between June 2012 and December 2014, 50 patients received additional chemotherapy with CAPOX regime (19%, 38%) or FOLFIRINOX (31%, 62%) after CRT. Median number of chemotherapy cycles received was four (range 2-8 cycles). Overall 34 (68%) patients underwent exploration and 31 (62%) underwent R0 resection. The median time to surgery following chemoradiation was 5 months (range 3-18 months). Complete pathological response was seen in seven (22%) patients.
Patients with poor response to NACRT may be further downstaged using additional chemotherapy so as to achieve R0 resection in 62% of cases.
一部分接受新辅助放化疗（NACRT）的局部晚期直肠癌患者仍无法切除。本研究旨在评估NACRT后对无法切除的直肠癌患者给予额外化疗的效果。
对NACRT反应不佳、直肠系膜筋膜在MRI上仍受累且R0切除可疑的患者，接受CAPOX或FOLFIRINOX方案的额外四个周期化疗，并用MRI重新评估反应并重新评估手术切除情况。
2012年6月至2014年12月期间，50例患者在CRT后接受了CAPOX方案（19%，38%）或FOLFIRINOX（31%，62%）的额外化疗。接受化疗周期的中位数为四个（范围2 - 8个周期）。总体上34例（68%）患者接受了探查，31例（62%）患者接受了R0切除。放化疗后至手术的中位时间为5个月（范围3 - 18个月）。7例（22%）患者出现完全病理缓解。
对NACRT反应不佳的患者可通过额外化疗进一步降期，从而在62%的病例中实现R0切除。
