Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2021 Sep;28(9):5194-5204. doi: 10.1245/s10434-021-10070-6. Epub 2021 May 22.
There is no consensus yet for the best treatment regimen in patients with recurrent rectal cancer (RRC). This study aims to evaluate toxicity and oncological outcomes after re-irradiation in patients with RRC in our center. Clinical (cCR) and pathological complete response (pCR) rates and radicality were also studied.
Between January 2010 and December 2018, 61 locally advanced RRC patients were treated and analyzed retrospectively. Patients received radiotherapy at a dose of 30.0-30.6 Gy (reCRT) or 50.0-50.4 Gy chemoradiotherapy (CRT) in cases of no prior irradiation because of low-risk primary rectal cancer. In both groups, patients received capecitabine concomitantly.
In total, 60 patients received the prescribed neoadjuvant (chemo)radiotherapy followed by surgery, 35 patients (58.3%) in the reRCT group and 25 patients (41.7%) in the long-course CRT group. There were no significant differences in overall survival (p = 0.82), disease-free survival (p = 0.63), and local recurrence-free survival (p = 0.17) between the groups. Patients in the long-course CRT group reported more skin toxicity after radiotherapy (p = 0.040). No differences were observed in late toxicity. In the long-course CRT group, a significantly higher cCR rate was observed (p = 0.029); however, there was no difference in the pCR rate (p = 0.66).
The treatment of RRC patients with re-irradiation is comparable to treatment with long-course CRT regarding toxicity and oncological outcomes. In the reCRT group, less cCR was observed, although there was no difference in pCR. The findings in this study suggest that it is safe and feasible to re-irradiate RRC patients.
对于复发性直肠癌（RRC）患者，目前尚无最佳治疗方案。本研究旨在评估本中心 RRC 患者再次放疗的毒性和肿瘤学结局。还研究了临床完全缓解（cCR）和病理完全缓解（pCR）率和根治性。
2010 年 1 月至 2018 年 12 月，对 61 例局部晚期 RRC 患者进行回顾性分析。对于因低危原发性直肠癌而未接受过放疗的患者，给予 30.0-30.6Gy（再 CRT）或 50.0-50.4Gy 放化疗（CRT）。两组均给予卡培他滨同步治疗。
共 60 例患者接受了规定的新辅助（化疗）放疗，随后接受了手术，再 CRT 组 35 例（58.3%），长程 CRT 组 25 例（41.7%）。两组的总生存（p=0.82）、无病生存（p=0.63）和局部无复发生存（p=0.17）无显著差异。长程 CRT 组患者在放疗后皮肤毒性反应发生率更高（p=0.040）。两组晚期毒性无差异。长程 CRT 组 cCR 率显著升高（p=0.029）；但 pCR 率无差异（p=0.66）。
对于 RRC 患者，再次放疗的治疗效果与长程 CRT 相似，在毒性和肿瘤学结局方面。在再 CRT 组中，观察到较少的 cCR，尽管 pCR 没有差异。本研究的结果表明，对 RRC 患者进行再放疗是安全可行的。
