Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
ANZ J Surg. 2024 Feb;94(1-2):175-180. doi: 10.1111/ans.18739. Epub 2023 Oct 17.
Management for locally advanced rectal cancer (LARC) conventionally comprises long-course chemoradiotherapy (LCCRT), total mesorectal excision (TME), and adjuvant chemotherapy. However, the RAPIDO study published in 2021 showed that total neoadjuvant therapy (TNT) led to better oncological outcomes without increased toxicity. We review the surgical and short-term oncological outcomes of patients with high-risk LARC who underwent TNT or LCCRT before TME.
Patients with high-risk LARC who underwent TNT or LCCRT before TME between 2021 and 2022 were reviewed.
Thirty-five patients (66%) had TNT as per RAPIDO whilst 18 underwent LCCRT. Median follow-up was 16 months (range 5-25). Of the patients who had TNT, median age was 65 years old (range 44-79), 34 (97%) had clinical Stage 3 LARC and median height FAV was 5 cm (range 0.5-14). Nine (26%) required a dose delay/reduction due to treatment toxicity. Seven (50%) showed resolution of previously enlarged lateral nodes. Three (9%) had pathological complete response. Postoperative major morbidity was 23%, of which 4 patients required a reoperation. Six (17%) patients had disease-related treatment failure, with two having disease progression during TNT, two developed local recurrence, and two developed distal metastasis following surgery. Median duration to surgery following completion of chemotherapy was significantly shorter with TNT (36 days versus 74 days) (P < 0.001). There were no other significant differences in outcomes.
TNT is clinically safe in high-risk LARC patients with no significant difference to surgical and short-term oncological outcomes compared to LCCRT, although a higher incidence of early surgical morbidity was observed.
局部晚期直肠癌（LARC）的传统治疗方法包括长程放化疗（LCCRT）、全直肠系膜切除术（TME）和辅助化疗。然而，2021 年发表的 RAPIDO 研究表明，总新辅助治疗（TNT）可提高肿瘤学疗效，且不会增加毒性。我们回顾了接受 TNT 或 LCCRT 联合 TME 治疗的高危 LARC 患者的手术和短期肿瘤学结果。
回顾了 2021 年至 2022 年间接受 TNT 或 LCCRT 联合 TME 治疗的高危 LARC 患者。
35 例（66%）患者按照 RAPIDO 方案接受 TNT，18 例患者接受 LCCRT。中位随访时间为 16 个月（5-25 个月）。TNT 组患者中位年龄为 65 岁（44-79 岁），34 例（97%）为临床 III 期 LARC，中位前阴道长度（FAV）为 5cm（0.5-14cm）。9 例（26%）因治疗毒性需要剂量延迟/减少。7 例（50%）患者先前增大的侧方淋巴结消失。3 例（9%）患者达到病理完全缓解。术后主要并发症发生率为 23%，其中 4 例患者需要再次手术。6 例（17%）患者发生疾病相关治疗失败，其中 2 例患者在 TNT 期间出现疾病进展，2 例患者发生局部复发，2 例患者在手术后发生远处转移。与 LCCRT 相比，TNT 组患者完成化疗后至手术的中位时间明显缩短（36 天 vs 74 天）（P<0.001）。两组间其他结局无显著差异。
TNT 治疗高危 LARC 患者是安全的，与 LCCRT 相比，手术和短期肿瘤学结果无显著差异，但观察到早期手术发病率较高。
