Li Jiannan, Zhang Boxiang, Guo Jie, Guo Yu, Chang Long, Wang Shu, Wang Min
Department of General Surgery, The Second Hospital of Jilin University, Changchun, China.
Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8538-8550. doi: 10.21037/qims-24-965. Epub 2024 Nov 7.
Patients with locally advanced rectal cancer (LARC) treated with surgery have a high risk of local recurrence. Intraoperative radiotherapy (IORT) is a promising method for treating locally advanced solid tumors, but there is limited research on the efficacy of IORT in treating LARC. This study aimed to evaluate the long-term efficacy of low-kV X-ray IORT in the treatment of LARC.
In total, 69 LARC patients with stage tumornodemetastasis (TNM) treated with radical resection and low-kV X-ray IORT at our center from December 2015 to August 2023 were consecutively included in this retrospective cohort study. Basic patient characteristics, intraoperative and postoperative data, and early and late complications were recorded. A Kaplan-Meier (K-M) survival analysis was performed to analyze the overall survival (OS) and disease-free survival (DFS) of the patients.
In total, 69 patients (median age, 64 years; 69.6% male) were enrolled in the study, and the median follow-up time was 47.5 months (range, 6.5-98.5 months). At the time of analysis, 15 patients had died (21.74%), 6 patients (8.70%) had been lost to follow-up, and 48 patients (69.57%) were alive. The 3-year OS and DFS rates were 89.42% and 71.47%, respectively. The local recurrence rate was 26.09%, and the 5-year local control, OS, and DFS rates were 78.90%, 68.59%, and 66.91%, respectively. The T stage of tumors was not predictive of either OS or DFS (P>0.05). However, different N stages and nerve/vascular invasion were found to be positively correlated with OS and DFS (P<0.05). Mortality within 30 days post-surgery was 0%. Early complications included anastomotic leak (5 cases, 7.25%), urinary retention (4 cases, 5.80%), diarrhea (7 cases, 10.14%), and bowel obstruction (4 cases, 5.80%), all of which were cured by conservative treatment. Late complications included ureteral obstruction (3 cases, 4.35%), bladder dysfunction (2 cases, 2.90%), sexual dysfunction (5 cases, 7.24%), and bowel obstruction (6 cases, 8.70%).
Our findings suggest that low-kV X-ray IORT enhances local control and survival in LARC patients. Further research should be conducted in larger, prospective trials.
接受手术治疗的局部晚期直肠癌（LARC）患者存在较高的局部复发风险。术中放疗（IORT）是治疗局部晚期实体肿瘤的一种有前景的方法，但关于IORT治疗LARC疗效的研究有限。本研究旨在评估低千伏X线IORT治疗LARC的长期疗效。
本回顾性队列研究连续纳入了2015年12月至2023年8月在本中心接受根治性切除及低千伏X线IORT治疗的69例肿瘤-淋巴结-转移（TNM）分期的LARC患者。记录患者的基本特征、术中及术后数据以及早期和晚期并发症。采用Kaplan-Meier（K-M）生存分析来分析患者的总生存期（OS）和无病生存期（DFS）。
本研究共纳入69例患者（中位年龄64岁；男性占69.6%），中位随访时间为47.5个月（范围6.5 - 98.5个月）。在分析时，15例患者死亡（21.74%），6例患者（8.70%）失访，48例患者（69.57%）存活。3年OS率和DFS率分别为89.42%和71.47%。局部复发率为26.09%，5年局部控制率、OS率和DFS率分别为78.90%、68.59%和66.91%。肿瘤的T分期对OS和DFS均无预测价值（P>0.05）。然而，不同的N分期以及神经/血管侵犯与OS和DFS呈正相关（P<0.05）。术后30天内死亡率为0%。早期并发症包括吻合口漏（5例，7.25%）、尿潴留（4例，5.80%）、腹泻（7例，10.14%）和肠梗阻（4例，5.80%），所有这些均通过保守治疗治愈。晚期并发症包括输尿管梗阻（3例，4.35%）、膀胱功能障碍（2例，2.90%）、性功能障碍（5例，7.24%）和肠梗阻（6例，8.70%）。
我们的研究结果表明，低千伏X线IORT可提高LARC患者的局部控制率和生存率。应开展更大规模的前瞻性试验进行进一步研究。
