N.N.Blokhin National Medical Research Center of Oncology, 23, Kashirskoe shosse, 115478, Moscow, Russian Federation.
"PET-technology" cancer center, 26, 50 let VLKSM st., 142110, Podolsk, Russian Federation.
Strahlenther Onkol. 2022 Feb;198(2):201-208. doi: 10.1007/s00066-021-01878-y. Epub 2021 Nov 25.
Rectal cancer patients who present with peritumoral abscesses and fistulas at the time of diagnosis may be denied chemoradiotherapy (CRT) as the safety is unknown. The aim of this study was to investigate the safety of preoperative CRT in this patient group.
We performed a retrospective nested case-control study to compare outcomes between patients with locally advanced rectal cancer with peritumoral abscesses and fistulas (study group) and patients with T4 locally advanced rectal cancer with no evidence of abscesses and fistulas (control group). These groups were matched by treatment center and radiotherapy delivery method. All patients received 50-54 Gy of conventionally fractionated RT with concurrent chemotherapy. Primary endpoint was grade 3-5 toxicity (by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE). Secondary endpoints included postoperative morbidity, pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) at 2 years.
A total of 33 patients were included in each group. Grade 3 toxicity was observed in 2 (6.1%) patients in the study group and 4 (12.1%) patients in the control group (p = 0.672). No patients developed grade 4-5 toxicity. Grade 3-4 Clavien-Dindo complications were observed in 5 (15.2%) patients in the study group and in 6 (18.2%) patients in the control group (p = 1.0). Pathologic CR was achieved in 3 (9.1%) and 5 (15.2%) patients, respectively (p = 0.708). Two-year OS was 78.3% vs. 81.8% (p = 0.944), 2‑year DFS was 62.8% vs. 69.7% (p = 0.693), respectively.
The presence of peritumoral abscesses and fistulas in patients with locally advanced rectal cancer is not associated with increased toxicity or inferior clinical outcomes after preoperative CRT.
诊断时伴有肿瘤周围脓肿和瘘管的直肠癌患者可能因安全性未知而被拒绝接受放化疗（CRT）。本研究旨在探讨该患者群体接受术前 CRT 的安全性。
我们进行了一项回顾性巢式病例对照研究，比较了伴有肿瘤周围脓肿和瘘管的局部晚期直肠癌患者（研究组）和无脓肿和瘘管的 T4 局部晚期直肠癌患者（对照组）之间的结局。这些组通过治疗中心和放疗方式进行匹配。所有患者均接受 50-54Gy 常规分割 RT 联合化疗。主要终点为 3-5 级毒性（根据美国国立癌症研究所不良事件常见毒性标准（NCI CTCAE））。次要终点包括术后发病率、病理完全缓解（pCR）、无病生存（DFS）和 2 年总生存（OS）。
每组各纳入 33 例患者。研究组中有 2 例（6.1%）患者发生 3 级毒性，对照组中有 4 例（12.1%）患者发生 3 级毒性（p=0.672）。没有患者发生 4-5 级毒性。研究组中有 5 例（15.2%）患者和对照组中有 6 例（18.2%）患者发生 3-4 级 Clavien-Dindo 并发症（p=1.0）。分别有 3 例（9.1%）和 5 例（15.2%）患者获得病理完全缓解（p=0.708）。2 年 OS 分别为 78.3%和 81.8%（p=0.944），2 年 DFS 分别为 62.8%和 69.7%（p=0.693）。
局部晚期直肠癌患者伴有肿瘤周围脓肿和瘘管并不增加术前 CRT 后的毒性或降低临床结局。
