{"title":"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。","authors":"Xinjue Shi, Siyao Zhong, Xianbin Zheng, Xianxiu Nan, Xuan Liu, Qiteng Liu, Jing Yuan, Yuyan Gao","doi":"10.1111/ajco.14199","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":8633,"journal":{"name":"Asia-Pacific journal of clinical oncology","volume":" ","pages":"e14199"},"PeriodicalIF":1.6000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Individualized T3-4N+ Rectal Cancer Treatment Strategies: Exploring the Efficacy of Preoperative Synchronized Lateral Lymph Node Simultaneous Integrated Boost Radiation Therapy.\",\"authors\":\"Xinjue Shi, Siyao Zhong, Xianbin Zheng, Xianxiu Nan, Xuan Liu, Qiteng Liu, Jing Yuan, Yuyan Gao\",\"doi\":\"10.1111/ajco.14199\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":8633,\"journal\":{\"name\":\"Asia-Pacific journal of clinical oncology\",\"volume\":\" \",\"pages\":\"e14199\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asia-Pacific journal of clinical oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ajco.14199\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asia-Pacific journal of clinical oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ajco.14199","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Individualized T3-4N+ Rectal Cancer Treatment Strategies: Exploring the Efficacy of Preoperative Synchronized Lateral Lymph Node Simultaneous Integrated Boost Radiation Therapy.
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.
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.
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