Jeon Youngbae, Han Kyoung-Won, Lee Seok Ho, Sym Sun Jin, Choi Seung Joon, Ha Seung Yeon, Baek Jeong-Heum
Division of Colon and Rectal Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Korean J Clin Oncol. 2021 Dec;17(2):111-116. doi: 10.14216/kjco.21017. Epub 2021 Dec 31.
Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases.
The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion.
Seven patients (five men and two women) underwent short-course RT (5×5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46-84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0-9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4-48.8 months and progression-free survival time of 14.7-41.1 months.
Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.
对于局部晚期直肠癌合并不可切除转移灶的患者，根治性治疗具有挑战性。本研究的目的是评估短程放疗（RT）联合全身化疗对直肠系膜筋膜（MRF）受累且有不可切除远处转移的直肠癌患者的临床疗效。
本研究纳入了2014年至2019年在吉尔医疗中心连续诊断为转移性中低位直肠癌并接受短程RT后再行全身化疗以进行转化性根治或姑息性手术的患者。这些患者的原发性直肠肿瘤累及MRF且有不可切除的远处转移。治疗策略在多学科团队讨论中确定。
7例患者（5例男性和2例女性）接受了短程RT（5×5 Gy）及术前全身化疗。中位年龄为68岁（范围46 - 84岁），从肛缘到原发性肿瘤的中位距离为6.0 cm（范围2.0 - 9.0 cm）。在中位随访期29.4个月期间，3例患者接受了R0切除的转化性根治手术，2例接受了姑息性手术，2例无法进行手术。未发生术后严重并发症或死亡。接受转化性根治手术的患者显示出良好的长期生存结果，总生存时间为29.4 - 48.8个月，无进展生存时间为14.7 - 41.1个月。
短程RT联合全身化疗可为不可切除的IV期直肠癌患者提供进行转化性根治手术的机会，并带来良好的长期生存结果。
