Wah Than Ngu, Mark Pritchard D, Hughes David M, Shing Yu Kai, Minnaar Helen S, Dhadda Amandeep, Mills Jamie, Folkesson Joakim, Radu Calin, Duckworth C A, Wong Helen, Ul Haq Muneeb, Sripadam Rajaram, Halling-Brown Mark D, Stewart Alexandra J, Sun Myint Arthur
Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, L69 3GE, UK.
The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK.
Clin Transl Radiat Oncol. 2024 Sep 6;49:100851. doi: 10.1016/j.ctro.2024.100851. eCollection 2024 Nov.
Radical surgery is the standard of care for early rectal cancer. However, alternative organ-preserving approaches are attractive, especially in frail or elderly patients as these avoid surgical complications. We have assessed the efficacy of sole Contact X-ray Brachytherapy (CXB) treatment in stage-1 rectal cancer patients who were unsuitable for or declined surgery.
This retrospective multi-centre study (2009-2021) evaluated 76 patients with T1/2-N0-M0 rectal adenocarcinomas who were treated with CXB alone. Outcomes were assessed for the entire cohort and sub-groups based on the T-stage and the criteria for receiving CXB alone; Group A: patients who were fit enough for surgery but declined, Group B: patients who were high-risk for surgery and Group C: patients who had received prior pelvic radiation for a different cancer.
With a median follow-up of 26(IQR:12-49) months, initial clinical Complete Response (cCR) was 82(70-93)% with rates of local regrowth 18(8-29)%, 3-year actuarial local control (LC) 84(75-95)%, distant relapse 3 %, and no nodal relapse. 5-year disease-free survival (DFS) and overall survival (OS) were 66(48-78)% and 58(44-75)%. Lower OS was observed in Groups B [HR:2.54(95 %CI:1.17, 5.59), p = 0.02] and C [HR:2.75(95 %CI:1.15, 6.58), p = 0.03]. Previous pelvic radiation predicted lower cCR and OS. The main toxicity was G1-2 rectal bleeding (26 %) and symptoms of impaired anal sphincter function were not reported in any patients.
CXB treatment alone achieved a high cCR rate with satisfactory LC and DFS. Inferior oncological outcomes were observed in patients who had received prior pelvic radiotherapy. CXB alone, with its favourable toxicity profile and avoidance of general anaesthesia and surgery risks, therefore, can be considered for patients who are unsuitable for or refuse surgery.
根治性手术是早期直肠癌的标准治疗方法。然而，保留器官的替代方法很有吸引力，尤其是对于体弱或老年患者，因为这些方法可避免手术并发症。我们评估了单纯接触X线近距离放射治疗（CXB）对不适合手术或拒绝手术的I期直肠癌患者的疗效。
这项回顾性多中心研究（2009 - 2021年）评估了76例仅接受CXB治疗的T1/2 - N0 - M0直肠腺癌患者。根据T分期和单纯接受CXB治疗的标准对整个队列和亚组的结果进行评估；A组：身体状况足以进行手术但拒绝手术的患者，B组：手术高风险患者，C组：因其他癌症曾接受盆腔放疗的患者。
中位随访26（IQR：12 - 49）个月，初始临床完全缓解（cCR）率为82（70 - 93）%，局部复发率为18（8 - 29）%，3年精算局部控制（LC）率为84（75 - 95）%，远处复发率为3%，无淋巴结复发。5年无病生存率（DFS）和总生存率（OS）分别为66（48 - 78）%和58（44 - 75）%。B组[HR：2.54（95%CI：1.17，5.59），p = 0.02]和C组[HR：2.75（95%CI：1.15，6.58），p = 0.03]的OS较低。既往盆腔放疗预示着较低的cCR和OS。主要毒性为1 - 2级直肠出血（26%），未报告任何患者有肛门括约肌功能受损症状。
单纯CXB治疗可实现较高的cCR率，LC和DFS令人满意。既往接受盆腔放疗的患者肿瘤学结局较差。因此，对于不适合手术或拒绝手术的患者，可考虑单纯CXB治疗，因其毒性特征良好，且避免了全身麻醉和手术风险。
