Abstract：Objective To retrospectively analyze the efficacy of pelvic radiotherapy and prognostic factors for stage IV rectal cancer. Methods From 2000 to 2010, 61 patients with stage IV rectal cancer who received pelvic radiotherapy with or without rectal surgery were enrolled as subjects. In those patients, 19 had both primary and metastatic tumors resected, 19 had only primary tumor resected, and 23 received pelvic radiotherapy with both primary and metastatic tumors intact. The Kaplan-Meier method was used to estimate survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Comparison of disaggregated data was made by Fisher′s exact test. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates in all patients were 26% and 17%, respectively. The prognostic analysis showed that stage T4, positive node, age greater than 65 years, metastasis outside the liver, and intact primary tumor were prognostic factors for OS, while stage T4, positive node, and intact primary tumor were prognostic factors for PFS. In patients with both primary and metastatic tumors resected, 5-year OS rates in patients treated with and without pelvic radiotherapy were 67% and 32%, respectively (P=0.119). In patients with intact metastatic tumor, 2-year OS rates in patients with resected and intact primary tumor were 52% and 27%, respectively (P=0.057). Only 4 patients who received pelvic radiotherapy alone for primary rectal tumor needed ostomy. Conclusions The value of postoperative pelvic radiotherapy still needs further studies in patients with stage IV rectal cancer and resectable metastatic tumor. Pelvic radiotherapy for primary tumor achieves definitive treatment outcomes in patients with stage IV rectal cancer and unresectable primary and metastatic tumors.
Ren Hua,Jing Hao,Jin Jing et al. An analysis of efficacy of pelvic radiotherapy and prognostic factors for stage IV rectal cancer[J]. Chinese Journal of Radiation Oncology, 2015, 24(5): 516-520.
[1] 陈万青.中国肿瘤登记地区合计发病和死亡结果[A]//赵平,陈万青.2010中国肿瘤登记年报[M].北京:军事医学科学出版社,2010:80-192. [2] Eadens MJ,Grothey A.Curable metastatic colorectal cancer[J].Curr Oncol Rep,2011,13(3):168-176.DOI:10.1007/s11912-011-0157-0. [3] Nordlinger B,Sorbye H,Glimelius B,et al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983):a randomised controlled trial[J].Lancet,2008,371(9617):1007-1016.DOI:10.1016/S0140-6736(08)60455-9. [4] Adam R,Delvart V,Pascal G,et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy:a model to predict long-term survival[J].Ann Surg,2004,240(4):644-657. [5] Schmoll HJ,Van Cutsem E,Stein A,et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making[J].Ann Oncol,2012,23(10):2479-2516.DOI:10.1093/annonc/mds236. [6] Nordlinger B,Sorbye H,Glimelius B,et al. Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983):long-term results of a randomised,controlled,phase 3 trial[J].Lancet Oncol,2013,14(12):1208-1215.DOI:10.1016/S1470-2045(13)70447-9. [7] Folprecht G,Gruenberger T,Bechstein WO,et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab:the CELIM randomised phase 2 trial[J].Lancet Oncol,2010,11(1):38-47.DOI:10.1016/S1470-2045(09)70330-4. [8] Van Cutsem E,Nordlinger B,Adam R,et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases[J].Eur J Cancer,2006,42(14):2212-2221.DOI:10.1016/j.ejca.2006.04.012. [9] Manfredi S,Lepage C,Hatem C,et al. Epidemiology and management of liver metastases from colorectal cancer[J].Ann Surg,2006,244(2):254-259. [10] Alberts SR,Horvath WL,Sternfeld WC,et al. Oxaliplatin,fluorouracil,and leucovorin for patients with unresectable liver-only metastases from colorectal cancer:a North central cancer treatment group phase Ⅱ study[J].J Clin Oncol,2005,23(36):9243-9249.DOI:10.1200/JCO.2005.07.740. [11] Boostrom SY,Vassiliki LT,Nagorney DM,et al. Synchronous rectal and hepatic resection of rectal metastatic disease[J].J Gastrointest Surg,2011,15(9):1583-1588.DOI:10.1007/s11605-011-1604-9. [12] Butte JM,Gonen M,Ding PR,et al. Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer[J].Cancer,2012,118(21):5414-5423.DOI:10.1002/cncr.27567. [13] Assumpcao L,Choti MA,Gleisner AL,et al. Patterns of recurrence following liver resection for colorectal metastases[J].Arch Surg,2008,143(8):743-749.DOI:10.1001/archsurg.143.8.743. [14] Kim JW,Kim YB,Kim NK,et al. The role of advent pelvic radiotherapy in rectal cancer with synchronous liver metastasis:a retrospective study[J].Radiat Oncol,2010,5(1):75.DOI:10.1186/1748-717X-5-75. [15] Logan JK,Huber KE,Dipetrillo TA,et al. Patterns of care of radiation therapy in patients with stage Ⅳ rectal cancer:a Surveillance,Epidemiology,and End Results analysis of patients from 2004 to 2009[J].Cancer,2014,120(5):731-737.DOI:10.1002/cncr.28467. [16] Crane CH,Janjan NA,Abbruzzese JL,et al. Effective pelvic symptom control using initial chemoradiation without colostomy in metastatic rectal cancer[J].Int J Radiat Oncol Biol Phys,2001,49(1):107-116.DOI:10.1016/S0360-3016(00)00777-X. [17] Stelzner S,Hellmich G,Koch R,et al. Factors predicting survival in stage Ⅳ colorectal carcinoma patients after palliative treatment:a multivariate analysis[J].J Surg Oncol,2005,89(4):211-217.DOI:10.1002/jso.20196. [18] Tyc-Szczepaniak D,Wyrwicz L,Kepka L,et al. Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases:a phase Ⅱ study[J].Ann Oncol,2013,24(11):2829-2834.DOI:10.1093/annonc/mdt363. [19] Zhu J,Lian P,Liu FQ,et al. Phase Ⅱ trial of first-line chemoradiotherapy with intensity-modulated radiation therapy followed by chemotherapy for synchronous unresectable distant metastases rectal adenocarcinoma[J/OL].Radiat Oncol,2013,8(1):10[2015-02-02].http://www.ro-journal.com/content/8/1/10.DOI:10.1186/1748-717X-8-10.
2015, Vol. 24 
