局部复发性直肠癌根治术后再发直肠癌分析。

IF 4.9 1区 医学 Q1 ONCOLOGY
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引用次数: 0

摘要

目的:目前缺乏指导局部复发直肠癌(LRRC)临床决策的实质性数据,特别是化放疗(CRT)的靶体积(TV)定义。我们对LRRC多模式治疗后的局部复发(re-LRRC)进行了逐例回顾,以确定re-LRRC的位置,并评估治疗是否可以改进:检索自 2016 年 10 月起在埃因霍温 Catharina 医院接受治愈性治疗的所有 LRRC 患者,这些患者均有完整的(再)LRRC 和放疗影像资料。患者在全体会议上与结直肠外科医生、放射肿瘤专家和放射科专家进行了讨论。每个病例都根据再LRRC位置、是否符合(当前)放疗方案以及回想起来多模式治疗是否会有所不同进行分类:讨论了 33 个病例。由于靶体积不同(13/17)和/或手术方式不同(9/17),17/33 例患者的 LRRC 治疗被认为不理想。15/33(46%)的再LRRC发生在之前放疗的TV区域内,可能显示出RT耐药。其他的再LRRC发生在场外(5例,15%)、边缘(6例,18%)或合并发生(7例,21%)。回想起来,48%的病例是按照目前的TV建议进行照射的。如果现在进行辐照,13/33 个病例的 TV 值会发生变化:本研究强调了当前 LRRC 标准治疗的改进空间。在所讨论的病例中,多达一半的病例采用不同的手术治疗或TV可能会改善预后。结合本研究的结果,进一步制定相关指南,可能会改善 LRRC 患者的肿瘤治疗效果,尤其是局部控制效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer

Purpose

Substantiating data guiding clinical decision making in locally recurrent rectal cancer (LRRC) is lacking, specifically in target volume (TV) definition for chemoradiotherapy (CRT). A case-by-case review of local re-recurrences (re-LRRC) after multimodal treatment for LRRC was performed, to determine location of re-LRRC and assess whether treatment could have been improved.

Methods

All patients treated with curative intent for LRRC at the Catharina Hospital Eindhoven from October 2016 onwards, in whom complete imaging of (re-)LRRC and radiotherapy was available, were retrieved. Patients were discussed in plenary meetings with expert colorectal surgeons, radiation oncologists and radiologists. Each case was classified based on re-LRRC location, whether it was in accordance with the (current) radiotherapy protocol, and whether multimodal management would have been different in retrospect.

Results

Thirty-three cases were discussed. LRRC treatment was deemed suboptimal in 17/33 patients, due to different target volumes (13/17) and/or different surgery (9/17). 15/33 (46 %) of re-LRRC developed in-field of the prior radiotherapy TV, possibly showing RT-resistant disease. Other re-LRRCs developed out-field (n = 5, 15 %), marginally (n = 6, 18 %), or in a combined fashion (n = 7, 21 %). In retrospect, 48 % of cases were irradiated in line with current TV recommendations. TVs of 13/33 cases would have been altered if irradiated today.

Conclusion

This study highlights room for improvement within current standard-ofcare treatment for LRRC. Different surgical management or TVs may have improved outcome in up to half of discussed cases. Further delineation guideline development, incorporating the results from this study, may improve oncological outcome, specifically local control, for LRRC patients.

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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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