Shi Chen, Zhang Yangzi, Li Yongheng, Geng Jianhao, Zhu Xianggao, Wang Hongzhi, Cai Yong, Wang Weihu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
J Oncol. 2022 Apr 11;2022:9119245. doi: 10.1155/2022/9119245. eCollection 2022.
In theory, the hyperfractionated radiotherapy can enhance biological effect dose against tumor and alleviate normal tissue toxicity. This study is to assess the efficacy and safety of preoperative hyperfractionated intensity-modulated radiotherapy (IMRT) with oral capecitabine in patients with locally advanced rectal cancer (LARC).
We retrospectively screened patients with LARC from January 2015 to June 2016. Patients that received hyperfractionated IMRT or conventional fractionated IMRT were eligible in the hyperfractionation (HF) group or conventional fractionation (CF) group, respectively. The primary outcome was the complete response rate. Secondary outcomes included toxicity, postoperative complications, anus-reservation operation rate, local recurrence and distant metastases rate, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).
335 patients were included in the analysis. The complete response rate for the hyperfractionated and conventional fractionated IMRT was 20.41% vs. 23.47% ( = 0.583). The anus-reservation operation rate was 68.37% vs. 65.31% ( = 0.649). There were no cases of grade 4 toxicity during radiotherapy; the rate of grade 3 toxicity and postoperative complications was both comparable between groups. However, in the CF group, more patients had a second operation due to complications (0.0% vs. 5.68%, = 0.011). The cumulative local regional recurrence and distant metastases rates of the HF group and CF group were 5.10% vs. 9.18% ( = 0.267) and 22.45% vs. 24.49% ( = 0.736), respectively. The 5-year OS, CSS, and DFS in the HF group and CF group were 86.45% vs. 73.30% ( = 0.503), 87.34% vs. 75.23% ( = 0.634), and 70.80% vs. 68.11% ( = 0.891), respectively.
The preoperative hyperfractionated IMRT with oral capecitabine, with an acceptable toxicity and favorable response and survival, could reduce the rate of secondary surgery.
理论上，超分割放疗可提高肿瘤生物效应剂量并减轻正常组织毒性。本研究旨在评估术前超分割调强放疗（IMRT）联合口服卡培他滨治疗局部晚期直肠癌（LARC）患者的疗效和安全性。
我们回顾性筛选了2015年1月至2016年6月期间的LARC患者。接受超分割IMRT或常规分割IMRT的患者分别纳入超分割（HF）组或常规分割（CF）组。主要结局为完全缓解率。次要结局包括毒性、术后并发症、保肛手术率、局部复发和远处转移率、总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS）。
335例患者纳入分析。超分割和常规分割IMRT的完全缓解率分别为20.41%和23.47%（P = 0.583）。保肛手术率分别为68.37%和65.31%（P = 0.649）。放疗期间无4级毒性病例；3级毒性和术后并发症发生率在两组间相当。然而，CF组更多患者因并发症进行二次手术（0.0%对5.68%，P = 0.011）。HF组和CF组的累积局部区域复发率和远处转移率分别为5.10%对9.18%（P = 0.267）和22.45%对24.49%（P = 0.736）。HF组和CF组的5年OS、CSS和DFS分别为86.45%对73.30%（P = 0.503）、87.34%对75.23%（P = 0.634）和70.80%对68.11%（P = 0.891）。
术前超分割IMRT联合口服卡培他滨，毒性可接受，反应和生存良好，可降低二次手术率。
