Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France.
Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China.
Swiss Med Wkly. 2021 Dec 15;151:w30034. doi: 10.4414/smw.2021.w30034. eCollection 2021 Dec 6.
This retrospective study was conducted to: (1) provide more modern data on real-life local management of metastatic rectal cancer; (2) compare therapeutic strategies; and (3) identify prognostic factors of local failure, overall survival and progression-free survival.
Data about efficacy and acute toxicity were collected. Patients were diagnosed with metastatic rectal cancer between 2004 and 2015, and were treated at least with radiotherapy. Local failure, overall survival and progression-free survival were correlated with patient, tumour and treatment characteristics using univariate and multivariate analyses.
Data of 148 consecutive patients with metastatic rectal cancer were analysed. Median follow-up was 19 months. Median overall survival was 16 months. All patients received local radiotherapy, with a median equivalent 2 Gy per fraction dose of 47.7 Gy. Rectal surgery was performed in 97 patients (65.6%). The majority of patients (86/97, 88.7%) received pre-operative chemoradiation. In multivariate analysis, rectal surgery was found to be the only independent predictor of increased overall survival (24.6 vs 7.1 months, p <0.001). Of the patients undergoing surgical treatment, 22.8% presented with significant complications that required a delay of systemic treatment. Grade 3-4 acute radiation therapy-related toxicities were observed in 6.1% of patients, mainly gastrointestinal toxicities (5.4%).
Rectal surgery was a key predictive factor of increased progression-free survival and overall survival in patients receiving at least local radiotherapy. In our series of real-life patients, local surgery and radiation seemed as well tolerated as reported in selected phase III non-metastatic rectal cancer patients. These data suggested that local management could be beneficial for metastatic rectal cancer patients.
本回顾性研究旨在：(1)提供转移性直肠癌真实局部管理的更现代数据；(2)比较治疗策略；(3)确定局部失败、总生存和无进展生存的预后因素。
收集了疗效和急性毒性的数据。患者于 2004 年至 2015 年间被诊断为转移性直肠癌，并至少接受了放疗。使用单变量和多变量分析，将局部失败、总生存和无进展生存与患者、肿瘤和治疗特征相关联。
分析了 148 例连续转移性直肠癌患者的数据。中位随访时间为 19 个月。中位总生存期为 16 个月。所有患者均接受局部放疗，中位等效 2 Gy 分次剂量为 47.7 Gy。97 例患者（65.6%）接受了直肠手术。大多数患者（86/97，88.7%）接受了术前放化疗。多变量分析显示，直肠手术是总生存增加的唯一独立预测因素（24.6 与 7.1 个月，p<0.001）。接受手术治疗的患者中，22.8%出现严重并发症，需要延迟全身治疗。3-4 级急性放疗相关毒性发生率为 6.1%，主要为胃肠道毒性（5.4%）。
直肠手术是接受至少局部放疗的患者无进展生存和总生存增加的关键预测因素。在我们的真实患者系列中，局部手术和放疗似乎与选定的 III 期非转移性直肠癌患者报告的一样耐受良好。这些数据表明，局部治疗可能对转移性直肠癌患者有益。
