Department of Radiation Oncology, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Via Dei Vestini, 66100, Chieti, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy.
J Cancer Res Clin Oncol. 2021 Apr;147(4):1179-1188. doi: 10.1007/s00432-020-03403-7. Epub 2020 Oct 7.
The effect of neoadjuvant chemoradiotherapy (CRT) and the relationship between pathological complete response (pCR) with clinical outcomes has been evaluated in elderly locally advanced rectal cancer (LARC) patients.
We retrospectively analyzed 117 LARC patients treated with conformal RT and concomitant fluoropirimidine-based chemotherapy. A dose of 4500 cGy, on the pelvis, up to 5500 cGy on the tumor was delivered. Multidisciplinary evaluation, including geriatric assessment, was previously performed to identify frail patients unsuitable for combined treatment.
The median age was 75 (range 70-88 years), and 103 (88%) patients had ECOG Performance Status (PS) = 0. All patients except one completed CRT. Ten (8.5%) patients temporarily suspended CRT for acute severe hematologic complication, diarrhea and/or proctitis and hypokalemia. Of the 103 operated patients (88%), a pCR, according to Mandard tumor regression grade (TRG) score, was obtained in 28 patients (27.2%), with TRG1-2 rate of 43.7%. The 3- and 5-year overall survival (OS) rates were 80.2% ± 4.2% and 68.0% ± 5.2%, 72.4% ± 4.5% and 57.8% ± 5.2% for disease-free survival (DFS), and 92.2% ± 2.8% and 89.5% ± 3.9% for loco-regional control. Patients with TRG1-2 had 3- and 5-year OS rates of 84.1% ± 6.6% and 84.1% ± 6.6% compared with 82.8% ± 5.5% and 67.7% ± 7.2% for patients with TRG3-5 (p = 0.012). The 3- and 5-year DFS rates for patients with TRG1-2 were 77.6% ± 7.0% and 74.2% ± 7.5% compared with 70.9% ± 6.3% and 54.7% ± 7.3% for patients with TRG3-5 (p = 0.009).
Our results reported good tolerability and clinical outcomes of neoadjuvant CRT, with a benefit in patients ≥ 70 years, confirming the prognostic role of pCR on clinical outcomes.
新辅助放化疗（CRT）的效果以及病理完全缓解（pCR）与临床结局的关系已在老年局部晚期直肠癌（LARC）患者中进行了评估。
我们回顾性分析了 117 例接受适形放疗和氟嘧啶类药物同期化疗的 LARC 患者。盆腔给予 4500 cGy，肿瘤部位给予 5500 cGy。在进行联合治疗之前，通过多学科评估（包括老年评估）确定不适合联合治疗的虚弱患者。
中位年龄为 75 岁（范围 70-88 岁），103 例（88%）患者的 ECOG 表现状态（PS）= 0。除 1 例患者外，所有患者均完成 CRT。10 例（8.5%）患者因急性严重血液学并发症、腹泻和/或直肠炎和低钾血症而暂时停止 CRT。在 103 例接受手术的患者（88%）中，根据 Mandard 肿瘤消退分级（TRG）评分，28 例（27.2%）患者获得 pCR，TRG1-2 率为 43.7%。3 年和 5 年总生存率（OS）分别为 80.2%±4.2%和 68.0%±5.2%，无病生存率（DFS）分别为 72.4%±4.5%和 57.8%±5.2%，局部区域控制率分别为 92.2%±2.8%和 89.5%±3.9%。TRG1-2 患者的 3 年和 5 年 OS 率分别为 84.1%±6.6%和 84.1%±6.6%，而 TRG3-5 患者的 3 年和 5 年 OS 率分别为 82.8%±5.5%和 67.7%±7.2%（p=0.012）。TRG1-2 患者的 3 年和 5 年 DFS 率分别为 77.6%±7.0%和 74.2%±7.5%，而 TRG3-5 患者的 3 年和 5 年 DFS 率分别为 70.9%±6.3%和 54.7%±7.3%（p=0.009）。
我们的结果报告了新辅助 CRT 的良好耐受性和临床结局，≥70 岁患者获益，证实了 pCR 对临床结局的预后作用。
