Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam.
Department of Surgery, University of Groningen, Groningen.
Br J Surg. 2020 Apr;107(5):537-545. doi: 10.1002/bjs.11418. Epub 2020 Feb 3.
The optimal treatment sequence for patients with rectal cancer and synchronous liver metastases remains unclear. The aim of this study was to evaluate the feasibility and effectiveness of short-course pelvic radiotherapy (5 × 5 Gy) followed by systemic therapy and local treatment of all tumour sites in patients with potentially curable stage IV rectal cancer in daily practice.
This was a retrospective study performed in eight tertiary referral centres in the Netherlands. Patients aged 18 years or above with rectal cancer and potentially resectable liver ± extrahepatic metastases, treated between 2010 and 2015, were eligible. Main outcomes included full completion of treatment schedule, symptom control and survival.
In total, 169 patients were included with a median follow-up of 49·5 (95 pr cent c.i. 43·6 to 55·6) months. The completion rate for the entire treatment schedule was 65·7 per cent. Three-year progression-free survival and overall survival (OS) rates were 24·2 (95 per cent c.i. 16·6 to 31·6) and 48·8 (40·4 to 57·2) per cent respectively. Median OS of patients who responded well and completed the treatment schedule was 51·5 months, compared with 15·1 months for patients who did not complete the treatment (P < 0·001). Adequate symptom control of the primary tumour was achieved in 87·0 per cent of all patients.
Multimodal treatment leads to relief of symptoms in most patients, and is associated with good survival rates in those able to complete the schedule. [Correction added on 12 February 2020, after first online publication: the Conclusion has been reworded for clarity].
对于同时患有直肠癌和肝转移的患者，最佳的治疗顺序仍不清楚。本研究旨在评估在日常实践中，对有潜在可治愈的 IV 期直肠癌患者，采用短程盆腔放疗（5×5Gy）加系统治疗，以及对所有肿瘤部位进行局部治疗的可行性和有效性。
这是一项在荷兰 8 个三级转诊中心进行的回顾性研究。纳入标准为年龄 18 岁或以上、患有直肠癌且有潜在可切除的肝转移灶±肝外转移灶、并于 2010 年至 2015 年间接受治疗的患者。主要结局包括完成治疗计划、症状控制和生存情况。
共纳入 169 例患者，中位随访时间为 49.5 个月（95%可信区间 43.6 至 55.6）。整个治疗计划的完成率为 65.7%。3 年无进展生存率和总生存率（OS）分别为 24.2%（95%可信区间 16.6 至 31.6）和 48.8%（40.4 至 57.2）。对治疗计划反应良好并完成治疗的患者中位 OS 为 51.5 个月，而未完成治疗的患者中位 OS 为 15.1 个月（P<0.001）。所有患者中，87.0%的患者实现了原发肿瘤的症状得到充分控制。
多模式治疗可使大多数患者的症状得到缓解，并且在能够完成治疗计划的患者中，与良好的生存率相关。
