Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery, Erasmus MC, Rotterdam, the Netherlands.
Eur J Surg Oncol. 2020 Sep;46(9):1605-1612. doi: 10.1016/j.ejso.2020.03.002. Epub 2020 Mar 6.
To investigate differences in postoperative outcomes between short-course radiotherapy and delayed surgery (SCRT-delay) and chemoradiation (CRT) in patients with locally advanced rectal cancer (LARC).
Previous trials suggest that SCRT-delay could serve as an adequate neoadjuvant treatment for LARC. Therefore, in frail LARC patients SCRT-delay is recommended as an alternative to CRT. However, data on postoperative outcomes after SCRT-delay in comparison to CRT is scarce.
This was an observational study with data from the Dutch ColoRectal Audit (DCRA). LARC patients who underwent surgery (2014-2017) after an interval of ≥6 weeks were included. Missing values were replaced by multiple imputation. Propensity score matching (PSM), using age, Charlson Comorbidity Index, cT-stage and surgical procedure, was applied to create comparable groups. Differences in postoperative outcomes were analyzed using Chi-square test for categorical variables, independent sample t-test for continuous variables and Mann-Whitney U test for non-parametric data.
2926 patients were included. In total, 288 patients received SCRT-delay and 2638 patients underwent CRT. Patients in the SCRT-delay group were older and had more comorbidities. Also, ICU-admissions and permanent colostomies were more common, as well as pulmonic, cardiologic, infectious and neurologic complications. After PSM, both groups comprised 246 patients with equivalent age, comorbidities and tumor stage. There were no differences in postoperative complications.
Postoperative complications were not increased in LARC patients undergoing SCRT-delay as neoadjuvant treatment. Regarding treatment-related complications, SCRT-delay is a safe alternative neoadjuvant treatment option for frail LARC patients.
探讨局部晚期直肠癌（LARC）患者中短程放疗和延迟手术（SCRT-delay）与放化疗（CRT）的术后结局差异。
先前的试验表明，SCRT-delay 可作为 LARC 的充分新辅助治疗。因此，在体弱的 LARC 患者中，SCRT-delay 被推荐作为 CRT 的替代方案。然而，关于 SCRT-delay 后与 CRT 相比的术后结果的数据很少。
这是一项来自荷兰 ColoRectal Audit（DCRA）的观察性研究。纳入了在≥6 周间隔后接受手术的 LARC 患者（2014-2017 年）。缺失值通过多次插补替换。使用年龄、Charlson 合并症指数、cT 分期和手术方式进行倾向评分匹配（PSM），以创建可比组。使用卡方检验分析分类变量的术后结局差异，使用独立样本 t 检验分析连续变量的术后结局差异，使用 Mann-Whitney U 检验分析非参数数据的术后结局差异。
共纳入 2926 例患者。共有 288 例患者接受 SCRT-delay，2638 例患者接受 CRT。SCRT-delay 组患者年龄较大，合并症较多。此外，ICU 入院和永久性结肠造口术更为常见，肺部、心脏、感染和神经系统并发症也更为常见。经过 PSM 后，两组各有 246 例患者，年龄、合并症和肿瘤分期相当。两组患者的术后并发症无差异。
作为新辅助治疗，LARC 患者接受 SCRT-delay 后并未增加术后并发症。关于治疗相关并发症，SCRT-delay 是体弱的 LARC 患者安全的新辅助治疗替代方案。
