Leiden University Medical Center, Department of Surgery, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, the Netherlands.
University Medical Center Groningen, Department of Medical Oncology, Hanzeplein 1, Postbus 30.001, 9700 RB Groningen, the Netherlands.
Eur J Cancer. 2023 May;185:139-149. doi: 10.1016/j.ejca.2023.02.027. Epub 2023 Mar 7.
Although optimising rectal cancer treatment has reduced local recurrence rates, many patients develop distant metastases (DM). The current study investigated whether a total neoadjuvant treatment strategy influences the development, location, and timing of metastases in patients diagnosed with high-risk locally advanced rectal cancer included in the Rectal cancer And Pre-operative Induction therapy followed by Dedicated Operation (RAPIDO) trial.
Patients were randomly assigned to short-course radiotherapy followed by 18 weeks of CAPOX or FOLFOX4 before surgery (EXP), or long-course chemoradiotherapy with optional postoperative chemotherapy (SC-G). Assessments for metastatic disease were performed pre- and post-treatment, during surgery, and 6, 12, 24, 36, and 60 months postoperatively. From randomisation, differences in the occurrence of DM and first site of metastasis were evaluated.
In total, 462 patients were evaluated in the EXP and 450 patients in the SC-G groups. The cumulative probability of DM at 5 years after randomisation was 23% [95% CI 19-27] and 30% [95% CI 26-35] (HR 0.72 [95% CI 0.56-0.93]; P = 0.011) in the EXP and SC-G, respectively. The median time to DM was 1.4 (EXP) and 1.3 years (SC-G). After diagnosis of DM, median survival was 2.6 years [95% CI 2.0-3.1] in the EXP and 3.2 years [95% CI 2.3-4.1] in the SC-G groups (HR 1.39 [95% CI 1.01-1.92]; P = 0.04). First occurrence of DM was most often in the lungs (60/462 [13%] EXP and 55/450 [12%] SC-G) or the liver (40/462 [9%] EXP and 69/450 [15%] SC-G). A hospital policy of postoperative chemotherapy did not influence the development of DM.
Compared to long-course chemoradiotherapy, total neoadjuvant treatment with short-course radiotherapy and chemotherapy significantly decreased the occurrence of metastases, particularly liver metastases.
尽管优化直肠癌治疗已降低了局部复发率，但仍有许多患者发生远处转移（DM）。本研究旨在探讨直肠局部进展期高危患者的新辅助全直肠治疗策略是否会影响转移的发展、部位和时间，这些患者被纳入 Rectal cancer And Pre-operative Induction therapy followed by Dedicated Operation（RAPIDO）试验。
患者被随机分配接受短程放疗联合 CAPOX 或 FOLFOX4 化疗 18 周（EXP 组），或长程放化疗联合术后可选化疗（SC-G 组）。在治疗前、治疗期间、手术期间以及术后 6、12、24、36 和 60 个月对转移疾病进行评估。自随机分组起，比较 DM 发生和首发转移部位的差异。
共纳入 462 例 EXP 组和 450 例 SC-G 组患者。随机分组后 5 年的 DM 累积发生率分别为 23%[95%CI 19-27]和 30%[95%CI 26-35]（HR 0.72[95%CI 0.56-0.93]；P=0.011）。EXP 和 SC-G 组 DM 中位时间分别为 1.4 年和 1.3 年。DM 诊断后，EXP 组和 SC-G 组中位生存时间分别为 2.6 年[95%CI 2.0-3.1]和 3.2 年[95%CI 2.3-4.1]（HR 1.39[95%CI 1.01-1.92]；P=0.04）。EXP 组和 SC-G 组 DM 首发部位最常见于肺部（60/462[13%]和 55/450[12%]）或肝脏（40/462[9%]和 69/450[15%]）。术后化疗的医院政策并未影响 DM 的发生。
与长程放化疗相比，短程放疗联合化疗的全直肠新辅助治疗显著降低了转移的发生，尤其是肝转移的发生。
