Individualized T3-4N+ Rectal Cancer Treatment Strategies: Exploring the Efficacy of Preoperative Synchronized Lateral Lymph Node Simultaneous Integrated Boost Radiation Therapy.

IF 1.6 4区医学 Q4 ONCOLOGY

Asia-Pacific journal of clinical oncology Pub Date : 2025-06-12 DOI:10.1111/ajco.14199

Xinjue Shi, Siyao Zhong, Xianbin Zheng, Xianxiu Nan, Xuan Liu, Qiteng Liu, Jing Yuan, Yuyan Gao

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引用次数: 0

Abstract

Objective: This study aims to assess the impact of preoperative synchronized lateral lymph node simultaneous integrated boost radiation therapy on the prognosis of T3-4N+ rectal cancer patients.

Methods: A retrospective analysis was performed on 35 patients with rectal cancer from Beijing Luhe Hospital affiliated to Capital Medical University from August 1, 2019 to April 30, 2023, including 22 patients with T3-4N+ rectal cancer, all of whom received the above preoperative therapy: planning gross tumor volume (PGTV): 95% PGTV 55 Gy/2.2 Gy/25 times; planning gross tumor volume of node (PGTVnd): 95% PGTVnd 60 Gy/2.4 Gy/25 times; and planning target volume (PTV): 95% PTV 50 Gy/2 Gy/25 times. Total mesorectal excision (TME) was performed 8-12 weeks after the radiotherapy. The primary endpoints were postoperative pathologic complete response (pCR) rate, downstaging rate, and 1-, 2-, and 3-year local regional recurrence-free survival (LRRFS). The secondary endpoints were anal retention rate, 1-, 2-, and 3-year event-free survival (EFS), overall survival (OS) rates, treatment-emergent adverse events (TEAEs), and perioperative complications.

Results: All 22 patients completed treatment, with pCR rate of 22.7% (5/22), anal preservation rate of 77.3% (17/22), tumor downstaging (T-downstaging) rate of 95.5% (21/22), and nodal downstaging (N-downstaging) rate of 100% (22/22), and 1-year postoperative LRRFS, EFS, and OS rates of 100%, 80%, and 86%, respectively; 2-year LRRFS, EFS, and OS rates of 90%, 63%, and 75%, respectively; and 3-year LRRFS, EFS, and OS rates of 90%, 63%, and 63%, respectively. Only two cases of Grade 3 adverse events occurred, which were clinically manageable and did not require permanent treatment cessation.

Conclusion: This retrospective analysis demonstrated encouraging short-term outcomes, including a 22.7% pCR rate and a 3-year LRRFS of 90%, with manageable toxicity. Nonetheless, these findings should be interpreted with caution due to the limited sample size and absence of a control arm.

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个体化T3-4N+直肠癌治疗策略：探讨术前同步侧淋巴结同步综合增强放疗的疗效。

目的：本研究旨在评估术前同步侧淋巴结同步综合增强放疗对T3-4N+直肠癌患者预后的影响。方法：回顾性分析首都医科大学附属北京鲁河医院2019年8月1日至2023年4月30日收治的35例直肠癌患者，其中T3-4N+直肠癌22例，均采用上述术前治疗方案：规划肿瘤总体积（PGTV） 95% PGTV 55 Gy/2.2 Gy/25次；规划淋巴结总肿瘤体积（PGTVnd）： 95% PGTVnd 60 Gy/2.4 Gy/25次；规划目标容积（PTV）： 95% PTV 50 Gy/2 Gy/25倍。放疗后8-12周行全肠系膜切除术（TME）。主要终点为术后病理完全缓解率（pCR）、降期率以及1年、2年和3年局部区域无复发生存率（LRRFS）。次要终点是肛门潴留率，1年、2年和3年无事件生存（EFS），总生存（OS）率，治疗中出现的不良事件（teae）和围手术期并发症。结果：22例患者全部完成治疗，pCR率22.7%(5/22)，肛门保存率77.3%(17/22)，肿瘤降期（t -降期）率95.5%(21/22)，淋巴结降期（n -降期）率100%(22/22)，术后1年LRRFS、EFS、OS率分别为100%、80%、86%；2年LRRFS、EFS和OS率分别为90%、63%和75%；3年LRRFS、EFS和OS率分别为90%、63%和63%。只有2例3级不良事件发生，这些不良事件在临床上是可控的，不需要永久停止治疗。结论：这项回顾性分析显示了令人鼓舞的短期结果，包括22.7%的pCR率和90%的3年LRRFS，毒性可控。尽管如此，由于样本量有限和缺乏对照组，这些发现应谨慎解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asia-Pacific journal of clinical oncology 医学-肿瘤学

CiteScore

3.40

自引率

0.00%

发文量

175

审稿时长

6-12 weeks

期刊介绍： Asia–Pacific Journal of Clinical Oncology is a multidisciplinary journal of oncology that aims to be a forum for facilitating collaboration and exchanging information on what is happening in different countries of the Asia–Pacific region in relation to cancer treatment and care. The Journal is ideally positioned to receive publications that deal with diversity in cancer behavior, management and outcome related to ethnic, cultural, economic and other differences between populations. In addition to original articles, the Journal publishes reviews, editorials, letters to the Editor and short communications. Case reports are generally not considered for publication, only exceptional papers in which Editors find extraordinary oncological value may be considered for review. The Journal encourages clinical studies, particularly prospectively designed clinical trials.