Yin Tzu-Chieh, Chen Po-Jung, Yeh Yung-Sung, Li Ching-Chun, Chen Yen-Cheng, Su Wei-Chih, Chang Tsung-Kun, Huang Ching-Wen, Huang Chun-Ming, Tsai Hsiang-Lin, Wang Jaw-Yuan
Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Oncol. 2023 Mar 30;13:1099168. doi: 10.3389/fonc.2023.1099168. eCollection 2023.
Neoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard treatment for patients with nonmetastatic locally advanced rectal cancer (LARC). However, for patients with LARC and synchronous metastasis, the optimal treatment strategy and sequence remain inconclusive. In the present study, we evaluated the efficacy and safety of concurrent radiotherapy in patients with metastatic rectal cancer who received chemotherapy and targeted therapy.
We retrospectively reviewed the data of 63 patients with LARC and synchronous metastasis who received intensive therapy at the study hospital between April 2015 and November 2018. The included patients were divided into two groups: RT-CT, those who received systemic chemotherapy with targeted therapy and concurrent radiotherapy (for primary rectal cancer), and CT, those who received only systemic chemotherapy with targeted therapy.
Treatment response was better in the RT-CT group than in the CT group. The rate of primary tumor resection (PTR) was higher in the RT-CT group than in the CT group (71.4% and 42.9%, respectively; = .0286). The RT-CT group exhibited considerably longer local recurrence-free survival ( = .0453) and progression-free survival (PFS; from 13.3 to 22.5 months) than did the CT group ( = .0091); however, the groups did not differ in terms of overall survival (OS; = .49). Adverse events were almost similar between the groups, except frequent diarrhea, the prevalence of which was higher in the RT-CT group than in the CT group (59.5% and 23.8%, respectively; = .0075).
In the era of biologics, radiotherapy may increase the resectability of primary rectal tumors, reducing the risk of locoregional failure and prolonging PFS. Concurrent pelvic radiotherapy may not substantially improve OS, which is indicated by metastasis. Hence, the resection of the distant metastases may be essential for improving long-term OS. To further determine the efficacy of concurrent radiotherapy, additional prospective, randomized studies must combine preoperative pelvic radiotherapy with PTR and metastectomy to treat patients with stage IV LARC.
新辅助放化疗后行全直肠系膜切除术是局部晚期直肠癌（LARC）患者的标准治疗方法。然而，对于LARC合并同步转移的患者，最佳治疗策略和顺序仍无定论。在本研究中，我们评估了接受化疗和靶向治疗的转移性直肠癌患者同步放疗的疗效和安全性。
我们回顾性分析了2015年4月至2018年11月期间在我院接受强化治疗的63例LARC合并同步转移患者的数据。纳入患者分为两组：RT-CT组，接受全身化疗联合靶向治疗及同步放疗（针对原发性直肠癌）；CT组，仅接受全身化疗联合靶向治疗。
RT-CT组的治疗反应优于CT组。RT-CT组的原发肿瘤切除率（PTR）高于CT组（分别为71.4%和42.9%；P = 0.0286）。RT-CT组的局部无复发生存期（P = 0.0453）和无进展生存期（PFS；从13.3个月延长至22.5个月）显著长于CT组（P = 0.0091）；然而，两组的总生存期（OS）无差异（P = 0.49）。两组的不良事件几乎相似，但RT-CT组腹泻发生率高于CT组（分别为59.5%和23.8%；P = 0.0075）。
在生物制剂时代，放疗可能提高原发性直肠肿瘤的可切除性，降低局部区域复发风险并延长PFS。同步盆腔放疗可能不会显著改善由转移导致的OS。因此，切除远处转移灶对于改善长期OS可能至关重要。为进一步确定同步放疗的疗效，必须开展额外的前瞻性随机研究，将术前盆腔放疗与PTR及转移灶切除术相结合，以治疗IV期LARC患者。
