Department of Medical Oncology, Mayo Clinic Cancer Center, Rochester, Minnesota, USA.
Department of Radiation Oncology, Mayo Clinic Cancer Center, Rochester, Minnesota, USA.
Oncologist. 2018 Jun;23(6):679-685. doi: 10.1634/theoncologist.2017-0456. Epub 2018 Feb 14.
The purpose of this study was to define survival rates in patients with isolated advanced abdominal nodal metastases secondary to colorectal cancer (CRC), treated with curative-intent trimodality therapy.
Sixty-five patients received trimodality therapy, defined as chemotherapy delivered with external beam radiotherapy (EBRT) followed by lymphadenectomy and intraoperative radiotherapy (IORT). Infusional 5-fluorouracil was the most common radiosensitizer used (63%, 41 patients). The median dose of EBRT was 50 Gy, and the median dose of IORT was 12.5 Gy. We evaluated time to distant metastasis, toxicities, local failure within the EBRT field, recurrence within the IORT field, and survival.
Fifty-two percent of patients were male; patients' median age was 50.5 years. All patients had an Eastern Cooperative Oncology Group score ≤1. Twenty-nine patients had right-sided colon cancer, 22 had left-sided colon cancer, and 14 had rectal primaries. The median time from initial CRC diagnosis to development of abdominal nodal metastatic disease was 20.6 months (95% confidence interval [CI], 21.2-40.8 months). Seventy-eight percent (51 patients) had para-aortic nodal metastases, 15% (10 patients) had mesenteric nodal metastases, and 6% (4 patients) had both. With a median follow-up of 77.6 months, the median overall survival and 5-year estimated survival rate were 55.4 months (95% CI, 47.2-80.9 months) and 45%, respectively. The median progression-free survival was 19.3 months (95% CI, 16.5-32.8 months). Twenty-six (40%) patients never developed distant disease. The outcome was not affected by disease sidedness or rectal primary. Treatment was well tolerated without grade 3 or 4 toxicities.
Trimodality therapy produces sustainable long-term survival in selected patients with metastatic CRC presenting with isolated retroperitoneal or mesenteric nodal relapse.
This article reports a unique trimodality approach incorporating external beam radiotherapy with radiosensitizing chemotherapy, surgical resection, and intraoperative radiotherapy provides durable survival benefit with significant curative potential for patients with metastatic colorectal cancer who present with isolated abdominal nodal (mesenteric and/or retroperitoneal) recurrence.
本研究旨在定义接受以治愈为目的的三联疗法治疗的结直肠癌（CRC）继发孤立性腹部淋巴结转移患者的生存率。
65 名患者接受了三联疗法，其定义为化疗联合外照射放疗（EBRT），然后进行淋巴结清扫术和术中放疗（IORT）。最常用的增敏剂为氟尿嘧啶输注（63%，41 例）。EBRT 的中位剂量为 50Gy，IORT 的中位剂量为 12.5Gy。我们评估了远处转移时间、毒性、EBRT 场局部失败、IORT 场复发和生存情况。
52%的患者为男性；患者中位年龄为 50.5 岁。所有患者的东部肿瘤协作组评分均≤1 分。29 名患者为右半结肠癌，22 名患者为左半结肠癌，14 名患者为直肠原发病。从初始 CRC 诊断到腹部淋巴结转移疾病发展的中位时间为 20.6 个月（95%置信区间[CI]，21.2-40.8 个月）。78%（51 名）患者有主动脉旁淋巴结转移，15%（10 名）有肠系膜淋巴结转移，6%（4 名）两者均有。中位随访 77.6 个月时，中位总生存期和 5 年估计生存率分别为 55.4 个月（95%CI，47.2-80.9 个月）和 45%。中位无进展生存期为 19.3 个月（95%CI，16.5-32.8 个月）。26 名（40%）患者从未出现远处疾病。疾病侧别或直肠原发病对结局无影响。治疗耐受性良好，无 3 或 4 级毒性。
三联疗法为转移性 CRC 患者提供了持久的长期生存，这些患者表现为孤立性腹膜后或肠系膜淋巴结复发。
本文报道了一种独特的三联疗法，包括外照射放疗联合增敏化疗、手术切除和术中放疗，为孤立性腹部淋巴结（肠系膜和/或腹膜后）复发的转移性结直肠癌患者提供了持久的生存获益，具有显著的治愈潜力。
