晚期直肠癌术前短程放疗与同步综合增强和反应适应化疗的早期疗效。

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2024-10-09 DOI:10.1016/j.clon.2024.10.005

B. Chan , N.S.M. Wong , B.B.W. Wo , O.L. Chan , A.S. Lee

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引用次数: 0

摘要

背景和目的：直肠癌新辅助短程放疗（SCRT）剂量升级的证据有限。过去几十年来，随着成像和放疗技术的提高，以及病理完全反应（pCR）这一重要终点的出现，我们相信，SCRT与同步综合增强疗法有可能提供更深层次的病理反应，并改善局部控制：回顾性分析了2020年1月至2022年12月期间接受新辅助SCRT治疗的局部区域晚期直肠癌患者的情况，SCRT同时进行综合增强，每分次高达5.5-6Gy，每天分5次，然后进行反应适应性化疗。结果：76名患者中，67人（88%）接受了根治性手术。99%（66 人）的患者实现了 R0 切除，pCR 率为 28%（19 人）。46%（n = 31）的患者病理分期显著降低（ypT2N0），55%（n = 37）的患者同时出现T和N分期降低。最常见的3级或以上放疗相关副作用是直肠炎、直肠疼痛和皮炎，分别有5%（4人）、3%（2人）和3%（2人）的患者出现这些副作用。15%（10 人）的患者出现 3 级或以上手术并发症。无治疗相关死亡病例。中位随访时间为27个月，只有6%的患者（4例）在术后出现局部复发：结论：直肠癌新辅助短程放疗与同步增强疗法是可行的，且不会增加毒性。接受手术治疗的患者可获得较高的 R0 切除率和 pCR 率。早期数据显示，局部复发率较低。还需要进一步的随访和研究来验证和优化剂量、方法和剂量递增计划。

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Early Outcomes of Preoperative Short Course Radiotherapy With Simultaneous Integrated Boost and Response-adapted Chemotherapy for Advanced Rectal Cancer

Background and purpose

Limited evidence exists for dose escalation in neoadjuvant short course radiotherapy (SCRT) for rectal cancer. With enhanced imaging and radiotherapy techniques over the past decades along with the valuable endpoint of pathological complete response (pCR), we believe SCRT with simultaneous integrated boost could potentially provide deeper pathological responses and improve local control.

Methods and Materials

Between January 2020 and December 2022, locoregional-advanced rectal cancer patients that were treated with neoadjuvant SCRT with simultaneous integrated boost up to 5.5–6Gy per fraction with five daily fractions followed by response-adapted chemotherapy was retrospectively reviewed. The pCR rates, R0 resection rates, tumor downstaging, toxicities, and early pattern of recurrence are reported.

Results

Among the 76 patients, 67 (88%) were able to undergo curative intent surgery. R0 resection was achieved in 99% (n = 66) of patients with pCR rates of 28% (n = 19). Forty-six percent (n = 31) of patients had significant pathological downstaging (ypT2N0) and 55% (n = 37) of patients had both T and N downstaging. Most common grade 3 or above radiotherapy-related side-effects were proctitis, rectal pain, and dermatitis found in 5% (n = 4), 3% (n = 2) and 3% (n = 2) of patients, respectively. Grade 3 or above surgical complications were observed in 15% (n = 10) of patients. There were no treatment-related deaths. With a median follow-up of 27 months, only 6% (n = 4) had local recurrence after surgery.

Conclusions

Neoadjuvant short course radiotherapy with simultaneous boost for rectal cancer is feasible with no added toxicities. Patients who underwent surgery achieve a high R0 resection and pCR rates. Early data suggest low rates of locoregional recurrence. Further follow-up and research is needed to validate and optimize the dose, method, and schedule of dose escalation.

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来源期刊

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.