Treder Maxi, Janssen Stefan, Holländer Niels Henrik, Schild Steven E, Rades Dirk
Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
Private Practice of Radiation Oncology, Hannover, Germany.
Anticancer Res. 2018 Sep;38(9):5371-5377. doi: 10.21873/anticanres.12866.
BACKGROUND/AIM: Controversy exists regarding treatment of high rectal cancer. The role of neoadjuvant radio-chemotherapy was investigated.
Fifty-four patients receiving neoadjuvant radio-chemotherapy (50.4 Gy & 2 courses of concurrent chemotherapy) for stage II/III high rectal cancer (10.1-15.0 cm from anal verge) were retrospectively analyzed. Following microscopicallly complete resection of primary tumor and involved lymph nodes in all patients, ≤6 courses of chemotherapy were given.
Five-year rates of local control (LC), metastases-free survival (MFS) and overall survival (OS) were 90%, 79% and 77%. On multivariate analyses, LC was associated with lower pathological UICC-stage at surgery (p=0.003) and successful downstaging (p=0.007), MFS with higher regression grade (p=0.014) and OS with lower Union for International Cancer Control (UICC)-stage (p=0.017) and downstaging (p=0.034). Grade 3 acute toxicities occurred in 19% of patients; grade ≥3 late toxicities were not observed. Manageable surgery-related complications occurred in 43%.
Neoadjuvant radio-chemotherapy for high rectal cancer was well tolerated and led to promising results. Comparative studies are required to investigate whether it is superior to postoperative chemotherapy alone.
背景/目的：高位直肠癌的治疗存在争议。本研究调查了新辅助放化疗的作用。
回顾性分析54例接受新辅助放化疗（50.4 Gy及2个周期同步化疗）的II/III期高位直肠癌（距肛缘10.1 - 15.0 cm）患者。所有患者在显微镜下完全切除原发肿瘤及受累淋巴结后，给予≤6个周期的化疗。
局部控制率（LC）、无转移生存率（MFS）和总生存率（OS）的5年率分别为90%、79%和77%。多因素分析显示，LC与手术时较低的病理UICC分期（p = 0.003）和成功降期（p = 0.007）相关，MFS与较高的消退分级（p = 0.014）相关，OS与较低的国际癌症控制联盟（UICC）分期（p = 0.017）和降期（p = 0.034）相关。19%的患者出现3级急性毒性反应；未观察到≥3级晚期毒性反应。43%的患者发生了可控的手术相关并发症。
高位直肠癌新辅助放化疗耐受性良好，效果令人满意。需要进行比较研究以探讨其是否优于单纯术后化疗。
