Kimura Kei, Beppu Naohito, Doi Hiroshi, Kataoka Kozo, Yamano Tomoki, Uchino Motoi, Ikeda Masataka, Ikeuchi Hiroki, Tomita Naohiro
Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
World J Gastrointest Oncol. 2020 Mar 15;12(3):311-322. doi: 10.4251/wjgo.v12.i3.311.
Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.
To investigate the clinical outcomes of patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy using tegafur/gimeracil/oteracil (S-1) plus irinotecan (CPT-11).
This was a single-center retrospective study of 82 patients who underwent radical surgery for rectal cancer after chemoradiotherapy with S-1 (80 mg/m/d), CPT-11 (60 mg/m/d), and radiation (total 45 Gy) between 2009 and 2016. The median follow-up was 51 mo (range: 17-116 mo).
Twenty-nine patients (35.4%) had T3 or T4 rectal cancer with mesorectal fascia invasion, 36 (43.9%) had extramural vascular invasion, 24 (29.8%) had N2 rectal cancer and eight (9.8%) had lateral lymph node swelling. The relative dose intensity was 90.1% for S-1 and 92.9% for CPT-11. Seventy-nine patients (96.3%) underwent R0 resection. With regard to pathological response, 13 patients (15.9%) had a pathological complete response and 52 (63.4%) a good response (tumor regression grade 2/3). The 5-year local recurrence-free survival, relapse-free survival and overall survival rates were 90.1%, 72.5% and 91.3%, respectively. We analyzed the risk factors for local recurrence-free survival by Cox regression analysis and none were detected. Previously described risk factors such as T4 stage, mesorectal fascia invasion or lateral lymph node swelling were not detected as negative factors for local recurrence-free survival.
We demonstrated good compliance and favorable tumor regression in patients with locally advanced rectal cancer treated with preoperative S-1 and CPT-11.
使用第二种药物的术前放化疗方案治疗局部晚期直肠癌仍在临床研究中。
探讨替吉奥（S-1）联合伊立替康（CPT-11）术前放化疗治疗局部晚期直肠癌患者的临床疗效。
这是一项单中心回顾性研究，纳入了2009年至2016年间接受S-1（80mg/m²/日）、CPT-11（60mg/m²/日）同步放化疗（总剂量45Gy）后行直肠癌根治术的82例患者。中位随访时间为51个月（范围：17 - 116个月）。
29例（35.4%）患者为T3或T4期直肠癌伴直肠系膜筋膜侵犯，36例（43.9%）有壁外血管侵犯，24例（29.8%）为N2期直肠癌，8例（9.8%）有侧方淋巴结肿大。S-1的相对剂量强度为90.1%，CPT-11为92.9%。79例（96.3%）患者行R0切除。病理反应方面，13例（15.9%）患者达到病理完全缓解，52例（63.4%）为良好反应（肿瘤退缩分级为2/3级）。5年局部无复发生存率、无复发生存率和总生存率分别为90.1%、72.5%和91.3%。通过Cox回归分析，我们未检测到局部无复发生存的危险因素。既往描述的危险因素如T4期、直肠系膜筋膜侵犯或侧方淋巴结肿大未被检测为局部无复发生存的负面因素。
我们证明了术前使用S-1和CPT-11治疗局部晚期直肠癌患者具有良好的依从性和肿瘤退缩效果。
