Margalit Ofer, Mamtani Ronac, Lawrence Yaacov R, Yang Yu-Xiao, Baruch Erez N, Reiss Kim A, Golan Talia, Halpern Naama, Aderka Dan, Giantonio Bruce, Shacham-Shmueli Einat, Boursi Ben
Department of Oncology, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 39040, Israel.
Mol Clin Oncol. 2019 May;10(5):555-559. doi: 10.3892/mco.2019.1825. Epub 2019 Mar 14.
In the neoadjuvant treatment of locally advanced rectal adenocarcinoma, long- and short-course radiotherapy are considered to be of equivalent efficacy based upon several randomized trials. The present study assessed the effect of radiotherapy dose on overall survival. Using the National Cancer Database (2006-2013) 458 individuals with clinical stage II/III rectal adenocarcinoma treated were identified, with either short- (25 Gy) or long- (45 or 50.4 Gy) course neoadjuvant radiotherapy followed by surgery, without neoadjuvant or adjuvant chemotherapy. Multivariate COX regression was employed to evaluate differences in overall survival according to radiotherapy regimen. An association with improved overall survival in individuals treated with long- compared with short-course radiotherapy was demonstrated (HR=0.50, 0.34-0.73). The 30- and 90-day post-surgery mortality rates were higher in the short-course group when compared with the long-course group (12.2 vs. 2.4%; and 18.5 vs. 5.4%, respectively). Following the exclusion of patients that succumbed within 90-days post-surgery, overall survival advantage in the long-course group compared with the short-course group was maintained [hazard ratio (HR)=0.62, 0.39-0.99], with a median overall survival of 25.3 months (IQR 16.9-41.6) for the short-course group compared with 43.5 months (IQR 25.6-67.9) for the long-course group. To the best of our knowledge, the present results suggest for the first time that long-course radiotherapy is associated with an improved overall survival compared with short-course radiotherapy in locally advanced rectal adenocarcinoma in the absence of chemotherapy usage. This possible advantage is clinically relevant mainly in patients who cannot tolerate systemic chemotherapy.
在局部晚期直肠腺癌的新辅助治疗中，基于多项随机试验，长疗程和短疗程放疗被认为疗效相当。本研究评估了放疗剂量对总生存期的影响。利用国家癌症数据库（2006 - 2013年），确定了458例临床II/III期直肠腺癌患者，这些患者接受了短疗程（25 Gy）或长疗程（45或50.4 Gy）新辅助放疗后进行手术，未接受新辅助或辅助化疗。采用多变量COX回归评估根据放疗方案的总生存期差异。结果表明，与短疗程放疗相比，接受长疗程放疗的患者总生存期有所改善（风险比[HR]=0.50，0.34 - 0.73）。与长疗程组相比，短疗程组术后30天和90天死亡率更高（分别为12.2%对2.4%；18.5%对5.4%）。在排除术后90天内死亡的患者后，长疗程组与短疗程组相比仍保持总生存期优势[风险比（HR）=0.62，0.39 - 0.99]，短疗程组的总生存期中位数为25.3个月（四分位间距16.9 - 41.6），长疗程组为43.5个月（四分位间距25.6 - 67.9）。据我们所知，目前的结果首次表明，在未使用化疗的情况下，局部晚期直肠腺癌患者中，长疗程放疗与短疗程放疗相比可改善总生存期。这种可能的优势在临床上主要与无法耐受全身化疗的患者相关。
