Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan.
Oncology. 2018;95(4):246-250. doi: 10.1159/000489930. Epub 2018 Jun 15.
The National Comprehensive Cancer Network (NCCN) guidelines recommend local excision and observation as standard treatment for selected patients with clinical T1N0M0 rectal cancer. In patients with pathological T1 (pT1) rectal cancer who received local excision, the local recurrence rate is at least 10%. We studied oncological outcomes in patients with pT1 rectal cancer who received chemoradiotherapy (CRT) after local excision.
Local excision was performed in 65 patients with clinical T1N0M0 rectal cancer (≤8 cm from the anal verge, tumor size < 30 mm, well or moderately differentiated adenocarcinoma). The patients received CRT (40 or 45 Gy in 1.8-2.0 fractions with concurrent oral UFT [tegafur/uracil] or S-1 [tegafur/gimeracil/ote-racil]) after confirmation of pT1 and negative margins.
Patients who had pT2 cancer or who did not provide informed consent were excluded. The remaining 50 patients additionally received CRT. The CRT was completed in 48 patients (96%). The median follow-up period was 71 months. Local recurrence occurred in 1 patient (2%). Distant metastases occurred in 3 patients (6%). The 5-year disease-free survival rate was 86%, and the 5-year overall survival rate was 92%.
Our study suggested that multidisciplinary treatment with local excision plus CRT can be used as a treatment option in selected patients with clinical T1N0M0 rectal cancer.
美国国家综合癌症网络（NCCN）指南建议对符合特定条件的临床 T1N0M0 期直肠癌患者采用局部切除加观察作为标准治疗方法。对于接受局部切除的病理 T1（pT1）期直肠癌患者，局部复发率至少为 10%。我们研究了接受局部切除后接受放化疗（CRT）的 pT1 期直肠癌患者的肿瘤学结局。
对 65 例临床 T1N0M0 期直肠癌（距肛门<8cm，肿瘤直径<30mm，高分化或中分化腺癌）患者进行了局部切除。在确认 pT1 和切缘阴性后，患者接受 CRT（40 或 45Gy，1.8-2.0 次/天，同步口服 UFT[替加氟/尿嘧啶]或 S-1[替加氟/吉美嘧啶/奥替拉西钾]）。
排除了患有 pT2 癌症或未提供知情同意的患者。其余 50 例患者还接受了 CRT。48 例患者（96%）完成了 CRT。中位随访时间为 71 个月。1 例患者（2%）出现局部复发。3 例患者（6%）出现远处转移。5 年无病生存率为 86%，5 年总生存率为 92%。
我们的研究表明，局部切除加 CRT 的多学科治疗可作为符合特定条件的临床 T1N0M0 期直肠癌患者的治疗选择。
