Liu Wenyang, Jin Jing, Li Yexiong, Wang Shulian, Song Yongwen, Liu Yueping, Wang Weihu, Ren Hua, Fang Hui, Li Ning, Tang Yuan, Wang Xin, Tang Yu, Lu Ningning, Xiao Qin, Feng Yanru, Wang Jianyang, Deng Lei, Jing Hao, Liu Xinfan, Yu Zihao
Departments of Radiation Oncology, National Cancer Center÷Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jun 25;21(6):654-659.
To evaluate the outcome of radical surgery combined with adjuvant radiotherapy for patients aged over 75 years with stage II( or III( rectal cancer.
From 2000 to 2010, 178 patients aged over 75 years at diagnosis who underwent radical surgery in National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, were selected from 3995 patients with stage II( or III( rectal cancer in the database of the above center and enrolled into this retrospective cohort study, which was approved by ethics committee of the above hospital (ClinicalTrials.gov number, NCT02312284).
Median age of patients was 77 years (range 75-87). There were 37 (20.8%), 69 (38.8%), and 72 (40.4%) patients with tumors locating in the high, middle and low rectum respectively; 89(50%) patients of pathological stages II( and III( respectively; 21(11.8%), 137(77%), 19(10.7%), and 1(0.6%) patients with poorly, moderately, well differentiated adenocarcinoma, and mucinous adenocarcinoma respectively. The Charlson/Deyo comorbidity index (CCI) score was 0 in the majority (73.6%) of patients. Fifty-three patients underwent abdominoperineal resection, 116 underwent low anterior resection and 9 underwent Hartmann resection. All the patients received computed tomography-based simulation and treatment planning using an anal marker in a prone or supine position. Patients were treated with linear accelerator by megavoltage photons (6MV), with 2D technique in early years and 3D conformal or simplified intensity-modulated radiotherapy technique later, at a dose of 50 Gy in 25 fractions to the pelvis within an overall treatment time of 35 days. Sixty-one patients (34.3%) received surgery combined with radiation (ART group), in whom 16 received radiation alone 117 patients did not receive radiation(NORT group). The baseline data between ART and NORT group were not significantly different(all P>0.05). There was no significant difference in 5-year overall survival between ART and NORT groups (61.0% vs. 63.0%, P=0.586). The cumulative local relapse was 10.9% and 25.4% in ART and NORT group respectively (P=0.032). Cox multivariate analysis revealed that surgery combined with radiation improved local control significantly(HR=0.27, 95%CI:0.11-0.68, P=0.005).
For elderly patients aged over 75 years with stage II( or III( rectal cancer, radical surgery combined with radiation does not increase the overall survival, but can improve local control rate. It is reasonable to selectively apply adjuvant radiotherapy to the elderly patients in the setting of radical surgery.
评估根治性手术联合辅助放疗对75岁以上Ⅱ期（或Ⅲ期）直肠癌患者的疗效。
从2000年至2010年，在中国医学科学院肿瘤医院、北京协和医学院肿瘤医院数据库中3995例Ⅱ期（或Ⅲ期）直肠癌患者中，选取178例诊断时年龄超过75岁且接受根治性手术的患者，纳入本回顾性队列研究，该研究经上述医院伦理委员会批准（ClinicalTrials.gov编号，NCT02312284）。
患者中位年龄为77岁（范围75 - 87岁）。肿瘤分别位于直肠上段、中段和下段的患者有37例（20.8%）、69例（38.8%）和72例（40.4%）；病理分期Ⅱ期和Ⅲ期的患者分别为89例（50%）；黏液腺癌、高分化腺癌、中分化腺癌和低分化腺癌患者分别有1例（0.6%）、19例（10.7%）、137例（77%）和21例（11.8%）。多数患者（73.6%）的Charlson/Deyo合并症指数（CCI）评分为0。53例患者接受腹会阴联合切除术，116例接受低位前切除术且9例接受Hartmann切除术。所有患者均使用肛门标记物在俯卧位或仰卧位进行基于计算机断层扫描的模拟和治疗计划。患者采用直线加速器通过兆伏光子（6MV）进行治疗，早年采用二维技术，后来采用三维适形或简化调强放疗技术，盆腔剂量为50 Gy，分25次给予，总治疗时间为35天。61例患者（3
