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The effect of local excision and adjuvant radiotherapy for patients with stageⅠrectal cancer
XIAO Qin, JIN Jing, LI Ye-xiong, WANG Shu-lian, WANG Wei-hu, SONG Yong-wen, LIU Yue-ping, REN Hua, FANG Hui, LIU Xin-fan, YU Zi-hao
Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China Corresponding author:JIN Jing,Email:jignjin25@yahoo.com.cn
Abstract Objective To evaluate the long-term survival and treatment failure patterns for patients with stage Ⅰ adenocarcinoma in the lower rectum after local excision with or without adjuvant radiotherapy. Methods From Jan. 2000 to Dec. 2008,Seventy-seven patients with rectal cancer received local excision. Among them, 41 received adjuvant radiotherapy. Fifty-four patients were pathologically proven as T1, the other 23 as T2. Patients were classified into low-and high-risk groups according to tumor grade, the length of tumor, surgical margin, circumference ratio of tumor/rectum and T stage. Survival rates and prognosticfactors were estimated by Kaplan-Meier method, and comparisons were made by the Logrank test. ResultsFourty patients were followed up more than 5 years. The 5-year locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were 83% and 82% for the whole group. There were no significant differences in 5-year LRFS and OS rates in low-risk patients between local excision alone and local excision followed by adjuvant radiotherapy (86%∶83%,χ2=0.29,P=0.588 and 100%∶100%,χ2=1.50,P=0.221). In high-risk patients, the 5-year LRFS were similar (80%∶82%,χ2=0.27,P=0.600),but the OS were significantly different (92%∶66%,χ2=4.64,P=0.031) between local excision alone and local excision followed by adjuvant radiotherapy. By univariate analysis, large tumor size, positive margin, poor differentiation, tumor located less than 5 cm from anal verge and pT2 stage were poor prognostic factors for OS. The overall relapse rate for the whole group was 29%, and 70% of them were locoregional relapse. The 5-year OS for patients treated with radical salvage surgery after local relapse was 69%. Conclusions For stage Ⅰ lower-sited rectal cancer,low-risk patients can achieve good result after local excision alone. The role of adjuvant radiotherapy in high-risk patients needs further evaluation. Local relapse is the main cause of failure, and salvage surgery after local relapse can provide long-term survival.
XIAO Qin,JIN Jing,LI Ye-xiong et al. The effect of local excision and adjuvant radiotherapy for patients with stageⅠrectal cancer[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 443-447.
XIAO Qin,JIN Jing,LI Ye-xiong et al. The effect of local excision and adjuvant radiotherapy for patients with stageⅠrectal cancer[J]. Chinese Journal of Radiation Oncology, 2012, 21(5): 443-447.
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2012, Vol. 21 
