Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Department of Surgery, Isala, Zwolle, The Netherlands.
Ann Surg Oncol. 2020 Sep;27(9):3503-3513. doi: 10.1245/s10434-020-08362-4. Epub 2020 Mar 19.
Despite improvements in the multimodality treatment for patients with locally recurrent rectal cancer (LRRC), oncological outcomes remain poor. This study evaluated the effect of induction chemotherapy and subsequent chemo(re)irradiation on the pathologic response and the rate of resections with clear margins (R0 resection) in relation to long-term oncological outcomes.
All consecutive patients with LRRC treated in the Catharina Hospital Eindhoven who underwent a resection after treatment with induction chemotherapy and subsequent chemo(re)irradiation between January 2010 and December 2018 were retrospectively reviewed. Induction chemotherapy consisted of CAPOX/FOLFOX. Endpoints were pathologic response, resection margin and overall survival (OS), disease free survival (DFS), local recurrence free survival (LRFS), and metastasis free survival (MFS).
A pathologic complete response was observed in 22 patients (17%), a "good" response (Mandard 2-3) in 74 patients (56%), and a "poor" response (Mandard 4-5) in 36 patients (27%). An R0 resection was obtained in 83 patients (63%). The degree of pathologic response was linearly correlated with the R0 resection rate (p = 0.026). In patients without synchronous metastases, pathologic response was an independent predictor for LRFS, MFS, and DFS (p = 0.004, p = 0.003, and p = 0.024, respectively), whereas R0 resection was an independent predictor for LRFS and OS (p = 0.020 and p = 0.028, respectively).
Induction chemotherapy in addition to neoadjuvant chemo(re)irradiation is a promising treatment strategy for patients with LRRC with high pathologic response rates that translate into improved oncological outcomes, especially when an R0 resection has been achieved.
尽管局部复发性直肠癌（LRRC）患者的多模态治疗有所改善，但肿瘤学结果仍然不佳。本研究评估了诱导化疗和随后的化疗（再）放疗对病理反应的影响，以及与长期肿瘤学结果相关的切缘清晰（R0 切除）的切除率。
回顾性分析 2010 年 1 月至 2018 年 12 月期间在 Catharina 医院埃因霍温接受诱导化疗和随后的化疗（再）放疗治疗后行切除术的所有连续 LRRC 患者。诱导化疗包括 CAPOX/FOLFOX。终点是病理反应、切缘和总生存（OS）、无病生存（DFS）、局部无复发生存（LRFS）和无转移生存（MFS）。
22 例（17%）患者观察到病理完全缓解，74 例（56%）患者出现“良好”反应（Mandard 2-3），36 例（27%）患者出现“较差”反应（Mandard 4-5）。83 例（63%）患者获得 R0 切除。病理反应程度与 R0 切除率呈线性相关（p=0.026）。在无同步转移的患者中，病理反应是 LRFS、MFS 和 DFS 的独立预测因素（p=0.004、p=0.003 和 p=0.024），而 R0 切除是 LRFS 和 OS 的独立预测因素（p=0.020 和 p=0.028）。
在新辅助化疗（再）放疗的基础上加入诱导化疗是治疗 LRRC 患者的一种很有前途的治疗策略，可提高病理反应率，从而改善肿瘤学结果，特别是当获得 R0 切除时。
