Steinke Jacqueline, Jordan Chloe, Rossides Savvas, Minnaar Helen, Yu Jimmy, Franklin Adrian, Rockall Tim, Dhadda Amandeep Singh, Andrew Hunter Iain, Mills Jamie, Chadwick Eliot, Silverman Rafael, Folkesson Joakim, Radu Calin, Myint Arthur Sun, Stewart Alexandra J
St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, England, United Kingdom.
University of Surrey, Guildford, England, United Kingdom.
Clin Transl Radiat Oncol. 2023 Jan 11;39:100580. doi: 10.1016/j.ctro.2023.100580. eCollection 2023 Mar.
The use of external beam radiotherapy (EBRT) and contact X-Ray brachytherapy (CXB) is emerging as an effective alternative in patients with early stage rectal cancer with the intent of organ preservation (OP). Short course radiotherapy (SCRT) is an alternative EBRT schedule for patients not fit for chemotherapy or for longer courses of EBRT. There are no multicentre studies that have reported on the outcomes of SCRT with a CXB boost, therefore we present these from patients from centres from the UK and Sweden.
From the Guildford Colorectal Database or local databases, 258 patients who underwent SCRT and CXB with the intent of OP from five centres treated between 2007 and 2019 were identified. Response and survival data was analysed and presented.
With a median age of 81, 226 patients were treated with radiotherapy alone (RTA) and 32 immediately after local excision (ILE). Median follow-up was 24 months. 70% and 97% of patients in the RTA and ILE groups respectively had a complete clinical response (cCR) after SCRT with CXB. Of those, local relapse was seen in 16% of the RTA and 3% of the ILE group. Median survival was 40 months after CXB in the RTA and 52 months in the ILE group. 94% of patients remained stoma-free to the point of latest follow-up.
This data suggests that CXB when combined with SCRT, in a mainly elderly and comorbid population, provides good palliation with stoma-avoidance. Oncological outcomes compare with previously published work. A greater focus is required on quality of life outcomes after OP.
对于早期直肠癌患者，采用外照射放疗（EBRT）和接触式X线近距离放疗（CXB）作为保留器官（OP）的有效替代方案正在兴起。短程放疗（SCRT）是不适合化疗或更长疗程EBRT患者的一种替代EBRT方案。尚无多中心研究报告SCRT联合CXB强化治疗的结果，因此我们呈现来自英国和瑞典中心患者的相关结果。
从吉尔福德结直肠癌数据库或本地数据库中，确定了2007年至2019年间在五个中心接受SCRT和CXB且目的为OP的258例患者。对反应和生存数据进行了分析和呈现。
患者中位年龄为81岁，226例患者仅接受了放疗（RTA），32例在局部切除（ILE）后立即接受治疗。中位随访时间为24个月。RTA组和ILE组分别有70%和97%的患者在接受SCRT联合CXB后获得了完全临床缓解（cCR）。其中，RTA组16%的患者和ILE组3%的患者出现了局部复发。CXB治疗后，RTA组的中位生存期为40个月，ILE组为52个月。94%的患者在最新随访时仍未造口。
该数据表明，在主要为老年和合并症患者中，CXB与SCRT联合使用可提供良好的姑息治疗并避免造口。肿瘤学结果与先前发表的研究相当。需要更加关注OP后的生活质量结果。
