同步整合加量调强放射治疗（SIB-IMRT）与非手术策略对伴有临床阳性盆腔侧方淋巴结的低位直肠癌患者预后的影响。
Effect of Simultaneous Integrated Boost Intensity Modulated Radiation Therapy (SIB-IMRT) and Non-Operative Strategy on Outcomes of Distal Rectal Cancer Patients with Clinically Positive Lateral Pelvic Lymph Node.
作者信息
Li Shuai, Geng Jianhao, Wang Lin, Teng Huajing, Wang Zhilong, Zhu Xianggao, Zhang Yangzi, Wang Hongzhi, Li Yongheng, Cai Yong, Wu Aiwen, Wang Weihu
机构信息
Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, People's Republic of China.
Department of Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, People's Republic of China.
出版信息
Cancer Manag Res. 2021 Jan 22;13:537-546. doi: 10.2147/CMAR.S286796. eCollection 2021.
BACKGROUND
We aimed to analyze the effect of simultaneous integrated boost intensity modulated radiation therapy (SIB-IMRT) and non-operative treatment on the clinical outcomes of distal rectal cancer patients exhibiting clinically positive lateral pelvic lymph nodes (LPLNs).
METHODS
We reviewed the medical records of patients diagnosed as having distal rectal adenocarcinoma with clinically positive LPLNs (≥7 mm, with irregular borders or mixed signal intensity) using primary pelvic magnetic resonance imaging (MRI). These patients had received SIB-IMRT-based neoadjuvant chemoradiotherapy (NCRT) and non-operative treatment according to the heterogeneity of the disease or personal preference. Chi-square tests were used to compare data between the two groups. Progression-free survival (PFS) and local regrowth were evaluated using the Kaplan-Meier method.
RESULTS
Between 2016 and 2019, we analyzed 75 patients diagnosed as having clinically positive LPLNs using primary MRI. SIB-IMRT was delivered to the planning positive LPLNs (PGTVn) at a total dose of 56-60 Gy. After NCRT, 23 patients underwent non-operative treatment. Among these patients, the median short axis of LPLNs was 8 mm (range: 7-21 mm). Fifteen patients were categorized into the mesorectal fascia (MRF)-positive group. The median follow-up duration for these patients was 19.8 months, and no patient exhibited LPLN regrowth. The 2-year PFS rate was 85.6% for non-operative patients, 74.6% for operative patients, and 90.0% for the pathological complete response (pCR) subgroup. Eighteen patients who underwent non-operative treatment were included in the clinical complete response (cCR) subgroup. The 2-year PFS and local regrowth rates in this group were similar to those in patients with clinically negative LPLN who achieved cCR. During NCRT, 21 (28.0%) patients experienced grade 2-3 acute reversible toxicity.
CONCLUSIONS
SIB-IMRT could eliminate metastases in LPLNs in a safe and effective manner, and non-operative strategies may be promising for cCR patients.
背景
我们旨在分析同步整合加量调强放射治疗（SIB-IMRT）及非手术治疗对临床诊断为盆腔侧方淋巴结（LPLNs）阳性的低位直肠癌患者临床结局的影响。
方法
我们回顾了经盆腔原发性磁共振成像（MRI）诊断为低位直肠腺癌且临床LPLNs阳性（≥7 mm，边界不规则或信号强度混杂）患者的病历。这些患者根据疾病异质性或个人偏好接受了基于SIB-IMRT的新辅助放化疗（NCRT）及非手术治疗。采用卡方检验比较两组数据。无进展生存期（PFS）和局部复发情况采用Kaplan-Meier法进行评估。
结果
2016年至2019年期间，我们分析了75例经原发性MRI诊断为临床LPLNs阳性的患者。SIB-IMRT给予计划靶区阳性LPLNs（PGTVn）的总剂量为56 - 60 Gy。NCRT后，23例患者接受了非手术治疗。在这些患者中，LPLNs的短轴中位数为8 mm（范围：7 - 21 mm）。15例患者被归入直肠系膜筋膜（MRF）阳性组。这些患者的中位随访时间为19.8个月，无患者出现LPLN复发。非手术患者的2年PFS率为85.6%，手术患者为74.6%，病理完全缓解（pCR）亚组为90.0%。18例接受非手术治疗的患者被纳入临床完全缓解（cCR）亚组。该组的2年PFS率和局部复发率与临床LPLN阴性且达到cCR的患者相似。在NCRT期间，21例（28.0%）患者出现2 - 3级急性可逆性毒性反应。
结论
SIB-IMRT能够安全有效地消除LPLNs中的转移灶，对于cCR患者，非手术策略可能具有前景。
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