Abstract：Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer. Methods From June 2007 to June 2013, 51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+)) were included in this study. Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0—50.4 Gy/25—28 fractions. Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy. Surgery was performed at 4—8 weeks after chemoradiotherapy. Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis. Results Forty-nine patients completed the preoperative chemoradiotherapy and surgery. The median follow-up was 2.9 years. The overall sphincter preservation rate was 65%;the overall downstaging rate was 59%. Ten (20.4%) of all patients achieved a pathologic complete response (pCR). Grade ≥3 toxicities occurred in 25% of all patients, and the overall postoperative complication rate was 31%. The 3-and 5-year sample sizes were 24,12, respectively. The 3-and 5-year overall survival rates were 81% and 69%, respectively;the 3-and 5-year disease-free survival (DFS) rates were 76% and 60%, respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78% and 70%, respectively;the distant metastasis-free survival rates were 82% and 74%, respectively. The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS. Conclusions For locally advanced middle-low rectal cancer, preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate, pCR rate, and sphincter preservation rate. Patients with tumor downstaging may have a better survival advantage.
Li Ming,Gao Hong,Li Gaofeng et al. Efficacy of preoperative concurrent chemoradiotherapy in treatment of locally advanced middle-low rectal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(4): 286-289.
[1] NCCN clinical practice guideline in oncology (NCCN Guidelines) rectal cancer version 4.2013[DB/OL][2014-01-25].http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. [2] 直肠癌规范化诊疗指南(试行)[J/OL].中国医学前沿杂志(电子版),2013,5:56-61. [3] Bosset JF, Calais G, Mineur L. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer:preliminary results—EORTC 22921[J].J Clin Oncol,2005,24:5620-5627. [4] Gerard JP, Conroy T, Bonnetain F. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers:results of FFCD 9203[J].J Clin Oncol,2006,28:4620-4625. [5] Bujko K, Nowacki MP, Nasierowska-Guttmejer A. Sphincter preservation following preoperative radiotherapy for rectal cancer:report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy[J]. Radiother Oncol,2004,1:15-24. [6] Sauer R, Becker H, Hohenberger W,et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med,2004,351:1731-1740. [7] Birgisson H, Pahlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer:long-term follow-up of the Swedish rectal cancer trial[J].J Clin Oncol,2005,23:8697-8705. [8] Roh MS, Yothers GA, OConnell MJ, et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum:NSABPR-04[J].J Clin Oncol,2011,29 Ssuppl:3503. [9] Aschele C, Cionini L, Lonardi S, et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer:pathologic results of the STAR-01 randomized phase Ⅲ trial[J].J Clin Oncol,2011,29:2773-2780. [10] Gérard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer:results of the phase Ⅲ trial ACCORD 12/0405-Prodige 2[J]. J Clin Oncol,2010,28:1638-1644. [11] Rdel C, Liersch T, Becker H, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer:initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial[J]. Lancet Oncol,2012,13:679-687. [12] 肖琴,金晶,李晔雄.局部晚期中低位直肠癌奥沙利铂联合卡培他滨术前同期放化疗的疗效分析[J].中华放射肿瘤学杂志,2014,23:99-103. [13] 詹天成,李明,顾晋. 解读美国结直肠外科医师协会2013直肠癌治疗指南[J].中华胃肠外科杂志,2013,16:701-709. [14] Park IJ, You YN, Agarwal A, et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer[J]. J Clin Oncol,2012,30:1770-1776. [15] Silberfein EJ, Kattepogu KM, Hu CY, et al. Long-term survival and recurrence outcomes following surgery for distal rectal cancer[J]. Ann Surg Oncol,2010,17:2863-2869. [16] Smith KD, Tan D, Das P, et al. Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation[J]. Ann Surg,2010,251:261-264. [17] Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes:MERCURY experience[J]. J Clin Oncol,2011,29:3753-3760. [18] 胡克,李文博,侯晓荣.局部进展期直肠癌术前新辅助治疗疗效分析[J].中华放射肿瘤学杂志,2011,20:502-505.
2014, Vol. 23 
