Division of Colorectal Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
Cancer Med. 2023 Dec;12(23):21209-21218. doi: 10.1002/cam4.6691. Epub 2023 Nov 6.
This study aimed to ascertain if the incorporation of intensity-modulated radiotherapy (IMRT) with chemotherapy (CTx) offered any advantages for patients diagnosed with stage pT3N0 rectal cancer located in the proximal (upper) region following a complete total mesorectum excision (TME).
We retrospectively examined medical records of stage II/III rectal cancer patients who had undergone CTx or concurrent chemoradiation (CCRT) with IMRT after a successful TME. We juxtaposed a variety of survival outcomes across two patient cohorts. Each outcome was further classified according to Gunderson's risk stratification between proximal and distal (middle and low) rectal cancer patients, and we evaluated the factors associated with each outcome.
The median follow-up duration was 4.9 years. Our research comprised 236 rectal adenocarcinoma patients treated at our institution between 2007 and 2019. They received either the CTx (n = 135) or the CCRT (n = 101) with 10-year locoregional recurrence-free survival (LRRFS) of 90.1% and 96.1%, respectively (p = 0.163). However, after performing multivariate adjustments, a pattern emerged hinting at a better LRRFS for the CCRT group (p = 0.052). Perforation had a strong correlation with locoregional recurrence. No significant differences were observed in other survival between the two treatment arms and their respective subgroups. The CCRT group witnessed significantly higher immediate and chronic complications with p = 0.007 and 0.009, respectively. The CCRT group had two secondary cancer-related fatalities (2%, one attributed to IMRT), and another reported by the CTx group (1%). The sole classified locoregional recurrence within the cohort of 37 individuals treated with CTx for proximal pT3N0 rectal cancer was, in fact, the development of sigmoid colon cancer.
The results suggest that for patients with proximal pT3N0 rectal cancer post-TME, IMRT is better when not combined with CTx, except in highly perilous scenarios or those involving perforation.
本研究旨在确定对于完全直肠系膜切除（TME）后位于近端（上部）区域的 pT3N0 直肠腺癌患者，在接受调强放疗（IMRT）联合化疗（CTx）与单纯 CTx 治疗后，是否存在优势。
我们回顾性分析了在成功 TME 后接受 CTx 或同步放化疗（CCRT）联合 IMRT 治疗的 II/III 期直肠腺癌患者的病历资料。我们将两种患者队列的各种生存结局进行了对比。根据 Gunderson 对近端和远端（中低位）直肠癌患者的风险分层，对每个结局进行了进一步分类，并评估了与每个结局相关的因素。
中位随访时间为 4.9 年。我们的研究包括 2007 年至 2019 年在我们机构治疗的 236 例直肠腺癌患者。他们接受 CTx（n=135）或 CCRT（n=101）治疗，10 年局部区域无复发生存率（LRRFS）分别为 90.1%和 96.1%（p=0.163）。然而，经过多变量调整后，CCRT 组的 LRRFS 更好（p=0.052）。穿孔与局部区域复发有很强的相关性。两组及其各自亚组之间的其他生存结果无显著差异。CCRT 组的急性和慢性并发症发生率明显更高（p=0.007 和 0.009）。CCRT 组有 2 例与癌症相关的死亡（2%，其中 1 例归因于 IMRT），而 CTx 组有 1 例报告。在接受 CTx 治疗的 37 例近端 pT3N0 直肠腺癌患者中，唯一分类为局部区域复发的患者实际上是乙状结肠癌的发生。
对于 TME 后位于近端的 pT3N0 直肠腺癌患者，IMRT 联合 CTx 治疗优于单纯 CTx 治疗，除非存在高危情况或穿孔。
