Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Colorectal Dis. 2019 Jun;21(6):663-670. doi: 10.1111/codi.14584. Epub 2019 Mar 8.
Recent data have suggested near-equivalent oncological results when treating early rectal cancer by local excision followed by radio- ± chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact X-ray brachytherapy within this paradigm.
All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact X-ray brachytherapy. Postoperative (chemo)radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, postoperative therapy received, follow-up duration, disease-free survival, salvage surgery and stoma-free survival.
In total, 180 patients with a median age of 70 (range 36-99) years were assessed. Following local excision, pT stages were pT1 = 131 (72%), pT2 = 44 (26%), pT3 = 5 (2%). All patients received contact X-ray brachytherapy boosting at our centre and, in addition, 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow-up of 36 months (range 6-48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (three isolated nodal), five underwent salvage abdominoperineal excision. Eight patients developed distant disease, of whom five underwent metastasis surgery. At last included follow-up 173 (96%) patients were free of all disease and 170 (94%) were stoma free.
Contact therapy can be offered in addition to external beam radio (±chemo) therapy instead of radical surgery as follow-on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial.
最近的数据表明，对于早期直肠癌，局部切除后行放射治疗±化疗而非挽救性根治性手术，其肿瘤学结果相当。本回顾性研究旨在评估在这一治疗模式中应用接触式 X 射线近距离放疗的效果。
所有患者均接受局部切除，并转诊至我院行接触式 X 射线近距离放疗。大多数患者还在当地医院接受术后（放）化疗。评估的变量包括局部切除方法、术后接受的治疗、随访时间、无疾病生存率、挽救性手术和无造口生存。
共评估了 180 例患者，中位年龄为 70 岁（范围为 36-99 岁）。局部切除后，pT 分期为 pT1 = 131 例（72%），pT2 = 44 例（26%），pT3 = 5 例（2%）。所有患者均在我院接受接触式 X 射线近距离放疗加量治疗，此外，110 例患者接受放化疗，60 例患者仅接受放疗。中位随访时间为 36 个月（范围为 6-48 个月），169 例（94%）患者无局部复发。11 例局部复发患者（3 例孤立淋巴结）中，5 例行挽救性腹会阴切除术。8 例患者发生远处转移，其中 5 例行转移灶切除术。末次随访时，173 例（96%）患者无任何疾病，170 例（94%）患者无造口。
对于早期直肠癌，在局部切除后，接触式放疗可与外照射放射治疗±化疗联合应用，而非根治性手术作为后续治疗。这种联合治疗可提供与根治性手术相当的效果。接触式放疗的附加价值应在临床试验中进行评估。
