Catalan Institute of Oncology, Radiation Oncology Department, L'Hospitalet de Llobregat, Barcelona, Spain.
Bellvitge University Hospital, General and Digestive Surgery Departement, L'Hospitalet de Llobregat, Barcelona, Spain.
Clin Transl Gastroenterol. 2020 Jun;11(6):e00162. doi: 10.14309/ctg.0000000000000162.
To date, we do not know the best therapeutic scheme in locally advanced rectal cancer when patients are older or have comorbidities.
In 2009, we established a prospective treatment protocol that included short-course preoperative radiotherapy (RT) with standard surgery +/- chemotherapy in frail patients, mostly older than 80 years or with comorbidities.
We included 87 patients; the mean follow-up was 43.5 months (0.66-106.3). Disease-specific survival and disease-free survival at 36 months were 86.3% and 82.8%; at 60 months, they were 78.2% and 78%, respectively, with a local recurrence rate of 2.5%. The rate of late radiotoxicity was 9% in the form of sacral insufficiency fracture and small bowel obstruction with one death. The interval before surgery varied according to the involvement of the mesorectal fascia, but it was less than 2 weeks in 45% of cases. The rate of R0 was 95%. Surgical complications included abdominal wound dehiscence (3.5%), anastomotic leak (2.4%), and reoperations (11.5%). Downstaging was observed in 51% of the cases, regardless of the interval before surgery.
Therapeutic outcomes in our group of elderly patients and/or patients with comorbidities with neoadjuvant short-course RT are such as those of the general population treated with neoadjuvant RT-chemotherapy, all with acceptable toxicity. Therefore, this treatment scheme, with short-course preoperative RT, would be the most appropriate in this group of patients.
迄今为止，我们尚不清楚对于老年或合并症患者局部进展期直肠癌的最佳治疗方案。
2009 年，我们建立了一个前瞻性治疗方案，包括对体弱患者（主要为 80 岁以上或合并症患者）行短程术前放疗（RT）加标准手术 +/-化疗。
我们共纳入 87 例患者；中位随访时间为 43.5 个月（0.66-106.3）。36 个月时疾病特异性生存率和无病生存率分别为 86.3%和 82.8%；60 个月时，分别为 78.2%和 78%，局部复发率为 2.5%。晚期放射性毒性发生率为 9%，表现为骶骨不足骨折和小肠梗阻，其中 1 例死亡。手术前的间隔时间根据直肠系膜筋膜的受累情况而不同，但 45%的病例少于 2 周。R0 率为 95%。手术并发症包括腹部切口裂开（3.5%）、吻合口漏（2.4%）和再次手术（11.5%）。51%的病例观察到降期，与手术前间隔时间无关。
我们组接受新辅助短程 RT 的老年患者和/或合并症患者的治疗结果与接受新辅助 RT-化疗的一般人群相似，且毒性可接受。因此，对于这类患者，短程术前 RT 是最合适的治疗方案。
