Center of Integrative Research, The First Hospital of Qiqihar, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.
Affiliated Qiqihar Hospital, Southern Medical University, 30 Gongyuan Road, Longsha District, Qiqihar, 161005, Heilongjiang, People's Republic of China.
World J Surg Oncol. 2020 Jun 17;18(1):132. doi: 10.1186/s12957-020-01903-x.
Patients with locally advanced colon cancer (LACC) treated with surgery had a high risk of local recurrence. The outcomes can vary significantly among patients with pT3 disease. This study was undertaken to assess whether low-kilovolt (kV) x-ray intraoperative radiotherapy (IORT) can achieve promising results compared with electron beam IORT (IOERT) and whether specific subgroups of patients with pT3 colon cancer may benefit from low-kV x-ray IORT.
We retrospectively reviewed 44 patients with pT3 LACC treated with low-kV x-ray IORT. Clinicopathologic characteristics were analyzed to identify patients that could potentially benefit from low-kV x-ray IORT. The Kaplan-Meier survival analysis was used to assess overall survival (OS) and progression-free survival (PFS). Correlation analysis was used to discover the association of multiple factors to the results of treatment represented by the values of OS and PFS.
The median follow-up of patients was 20.5 months (range, 6.1-38.8 months). At the time of analysis, 38 (86%) were alive and 6 (14%) had died of their disease. The 3-year Kaplan-Meier of PFS and OS for the entire cohort was 82.8% and 82.1%, respectively. At median follow-up, no in-field failure within the low-kV x-ray IORT field had occurred. Locoregional and distant failure had occurred in 2 (5%) patients each. The rate of perioperative 30-day mortality was 0%, and the morbidity rate was 11%. Five patients experienced 7 complications, including 4 early complications (30 days) and three late complications (> 30 days) leading early and late morbidity rates of 9% and 7%, respectively.
Patients with LACC who had undergone an additional low-kV x-ray IORT can achieve encouraging locoregional control, PFS, OS, and distant control without an increase in short-term or long-term complications. Low-kV x-ray IORT can be considered as part of management in pT3 LACC.
接受手术治疗的局部晚期结肠癌（LACC）患者局部复发风险较高。pT3 疾病患者的结果可能有很大差异。本研究旨在评估低千伏（kV）X 射线术中放疗（IORT）与电子束 IORT（IOERT）相比是否能取得令人满意的结果，以及 pT3 结肠癌患者的特定亚组是否可能从低千伏 X 射线 IORT 中获益。
我们回顾性分析了 44 例接受低千伏 X 射线 IORT 治疗的 pT3 LACC 患者。分析临床病理特征，以确定可能从低千伏 X 射线 IORT 中获益的患者。采用 Kaplan-Meier 生存分析评估总生存率（OS）和无进展生存率（PFS）。相关性分析用于发现多个因素与以 OS 和 PFS 表示的治疗结果之间的关系。
患者的中位随访时间为 20.5 个月（范围，6.1-38.8 个月）。在分析时，38 例（86%）存活，6 例（14%）死于疾病。整个队列的 3 年 Kaplan-Meier PFS 和 OS 分别为 82.8%和 82.1%。在中位随访时，低千伏 X 射线 IORT 场中未发生场内失败。局部和远处失败各发生在 2 例（5%）患者中。围手术期 30 天死亡率为 0%，发病率为 11%。5 例患者发生 7 例并发症，包括 4 例早期并发症（30 天）和 3 例晚期并发症（>30 天），导致早期和晚期发病率分别为 9%和 7%。
接受额外低千伏 X 射线 IORT 的 LACC 患者可实现令人鼓舞的局部控制、PFS、OS 和远处控制，且短期和长期并发症无增加。低千伏 X 射线 IORT 可被视为 pT3 LACC 治疗的一部分。
