Tang Zhongzhu, Liu Luying, Liu Dong, Wu Lie, Lu Ke, Zhou Ning, Shen Jinwen, Chen Guiping, Liu Guan
Department of Abdominal Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences & Zhejiang Cancer Hospital, Hangzhou, People's Republic of China.
Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China.
Cancer Manag Res. 2020 Nov 30;12:12277-12286. doi: 10.2147/CMAR.S278427. eCollection 2020.
Optimal approaches to patients with local recurrence of rectal cancer are unclear in China. This study aimed to evaluaty -30te the clinical outcomes and toxicity associated with different treatment regimens for patients with local recurrence of rectal cancer.
A retrospective chart review of patients with local recurrence of rectal cancer and previous radical surgical treatment between March 2010 and December 2017 with curative intent was performed. Disease-related endpoints included treatment progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. Toxicities were assessed using Common Terminology Criteria for Adverse Events, version 5.0, and complications were scored according to the Clavien-Dindo classification.
A total of 71 patients met the inclusion criteria in this study. The recurrence sites were mainly local recurrence in the pelvic cavity and regional lymph node metastasis. Twenty patients received chemoradiotherapy combined with surgery, 10 underwent surgery alone, and others received chemoradiotherapy-alone (n = 27) and chemotherapy-alone (n = 14) treatment. A clear difference was found in PFS between surgery/chemoradiotherapy with surgery and chemoradiotherapy/chemotherapy groups (26.6 months vs 14.1 months, = 0.033). The PFS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 65.2 months, 20.2 months, and 14.2 months, respectively ( = 0.042). The multivariate analysis of PFS demonstrated that surgery was an independent factor. The proportion of patients with distant metastases after chemoradiotherapy/chemotherapy was higher than that of patients undergoing surgery (36.6% vs 21.4%, = 0.179). The OS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 89.4 months, 66.0 months, and 62.8 months, respectively ( = 0.189). Radiation treatment and surgery did not increase extra severe toxicities.
Surgery combined with chemoradiotherapy was a beneficial treatment mode for managing patients with locally recurrent, nonmetastatic rectal cancer. It was associated with better local disease control, no increase in toxicity, and prolonged survival among patients with locally recurrent rectal cancer.
在中国，针对直肠癌局部复发患者的最佳治疗方法尚不清楚。本研究旨在评估直肠癌局部复发患者不同治疗方案的临床结局和毒性。
对2010年3月至2017年12月间有根治性手术史的直肠癌局部复发患者进行回顾性病历审查。疾病相关终点包括采用Kaplan-Meier法计算的无进展生存期（PFS）和总生存期（OS）。使用不良事件通用术语标准第5.0版评估毒性，并根据Clavien-Dindo分类对并发症进行评分。
本研究共有71例患者符合纳入标准。复发部位主要为盆腔局部复发和区域淋巴结转移。20例患者接受了放化疗联合手术，10例仅接受手术，其他患者接受单纯放化疗（n = 27）和单纯化疗（n = 14）治疗。手术/放化疗联合手术组与放化疗/化疗组的PFS存在明显差异（26.6个月对14.1个月，P = 0.033）。放化疗联合手术、单纯手术以及化疗/放化疗组患者的PFS分别为65.2个月、20.2个月和14.2个月（P = 0.042）。PFS的多因素分析表明手术是一个独立因素。放化疗/化疗后远处转移患者的比例高于接受手术的患者（36.6%对21.4%，P = 0.179）。放化疗联合手术、单纯手术以及化疗/放化疗组患者的OS分别为89.4个月、66.0个月和62.8个月（P = 0.189）。放疗和手术并未增加额外的严重毒性。
放化疗联合手术是治疗局部复发、无转移直肠癌患者的有益治疗模式。它与更好的局部疾病控制相关，不会增加毒性，并能延长局部复发直肠癌患者的生存期。
