Abstract Objective To evaluate the efficacy and safety of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer (LARC) before surgery. Methods A total of 291 LARC patients who received preoperative chemoradiotherapy and surgery with or without postoperative adjuvant chemotherapy from March 2003 to May 2012 were included in the study. The radiotherapy delivered was two-dimensional conformal radiotherapy (2DRT) and three-dimensional conformal radiotherapy (3DRT), and the total dose ranged from 45 to 50 Gy in 23－25 fractions. All the patients received preoperative chemotherapy including FOLFOX6, XELOX, and Xeloda for 2－4 cycles. Surgery following the principle of total mesorectal excision was performed 3－8 weeks after radiotherapy. Postoperative adjuvant chemotherapy was delivered to 134 patients. The overall survival (OS), disease-free survival (DFS),relapse-free survival (RFS), and distant metastasis-free survival (DMFS) were determined using the Kaplan-Meier method, and survival difference analysis and univariate prognostic analysis were performed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results All the patients completed the preoperative neoadjuvant chemoradiotherapy and surgery. The rate of radical resection (R0) was 98.9%, and the sphincter preservation rate was 53.6%. The downstaging rates in tumor (T) stage, node (N) stage, and clinical stage were 73.1%, 83.6%, and 79.4%, respectively. Pathologic complete response rate was 26.8%. Grade 3 adverse hematologic reactions, grade 3 diarrhea, and grade 3 radiodermatitis were observed in 7.9%, 7.2% and 2.7% of total patients, respectively. Postoperative perineal pain and delayed wound healing were reported in 12.3% and 8.2% of total patients, respectively. The follow-up rate was 94.5% and the 5-year sample size was 95 patients. The 5-year OS, DFS, RFS, and DMFS were 76.6%, 72.1%, 88.8%, and 79.7%, respectively. The 5-year local recurrence rate and distant metastasis rate were 7.5% and 15.8%, respectively. Multivariate analysis revealed that the postoperative pathological staging was a prognostic influencing factor. Conclusions Preoperative neoadjuvant chemoradiotherapy increases the R0 and sphincter preservation rates, and results in significant tumor downstaging. Treatment-related adverse reactions are moderate and perioperative complications are not increased. The local recurrence rate is low and long-term survival rate is increased. Clinical application of preoperative neoadjuvant chemoradiotherapy as a standard treatment regimen for LARC is highly recommended.
Huang Rong,Zhang Luning,Xiao Weiwei et al. Efficacy and safety of preoperative neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer:a clinical analysis of 291 patients[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 143-148.
Huang Rong,Zhang Luning,Xiao Weiwei et al. Efficacy and safety of preoperative neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer:a clinical analysis of 291 patients[J]. Chinese Journal of Radiation Oncology, 2015, 24(2): 143-148.
[1]Ke TW,Liao YM,Chiang HC,et al. Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage Ⅱ－Ⅲ rectal cancer:a population-based study[J/OL].Asia Pac J Clin Oncol,2014 Jan 24[2014-07-10].http://onlinelibrary.wiley.com/doi/10.1111/ajco.12172/abstract;jsessionid=8E2B0F2CA2DEA1BAFED41F03A52004E6.f03t02.DOI:10.1111/ajco.12172. [2]Gerard JP,Conroy T,Bonnetain F,et al. Preoperative radiotherapy with or without concurrent fluouracil and leucovorin in T3－4 rectal cancers:results of FFCD 9203[J].J Clin Oncol,2006,24(28):4620-4625. [3]Borner MM,Dietrich D,Stupp R,et al. Phase Ⅱ study of capecitabine and oxaliplatin in first-and second-line treatment of advanced or metastatic colorectal cancer[J].J Clin Oncol,2002,20(7):1759-1766. [4]Sauer R,Becker H,Hohenberger W,et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J].N Engl J Med,2004,351(17):1731-1740. [5]Valentini V,Coco C,Cellini N,et al.preoperative chemoradiation for extraperitoneal T3 rectal cancer:acute toxicity,tumor response,and sphincter preservation[J].Int J Radiat Oncol Biol Phy,1998,40(5):1067-1075. [6]Janjan NA,Khoo VS,Abbruzzese J,et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer[J].Int J Radiat Oncol Biol Phys,1999,44(5):1027-1038. [7]Valenti V,Hemander-lizoain J Z,Baixauli J,et al. Analysis of early postoperative morbidity among patients with rectal cancer treated with and without neoadjuvant chemoradiotherapy[J].Ann Surg Oncol,2007,14(5):1744-1751. [8]Roh MS,Colangelo LH,O′Connell MJ,et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum:NSABP R-03[J].J Clin Oncol,2009,27(31):5124-5130.DOI:10.1200/JCO.2009.22.0467. [9]Park IJ,Choi GS,Lim KH,et al. Laparoscopic resection of extra-peritoneal rectal cancer:a comparative analysis with open resec-tion[J].Surg Endosc,2009,23(8):1818-1824. [10]Braga M,Frasson M,Vignali A,et al. Laparoscopic resection inrectal cancer patients:outcome and cost-benefit analysis[J].Dis Colon Rectum,2007,50(4):464-471. [11]Paun BC,Cassie S,Maclean AR,et al. Postoperative complications following surgery for rectal cancer[J].Ann Surg,2010,251(5):807-818. [12]van der pas MH,Haglind E,Cuesta MA,et al. Laparoscopic versus open surgery for rectal cancer (COLOR Ⅱ):short-term outcomes of a randomized,phase 3 trial[J].Lancet Oncol,2013,14(3):210-218. [13]Guillou PJ,Quirke P,Thorpe H,et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial):multicentre,randomised controlled trial[J].Lancet,2005,365(9472):1718-1726. [14]Zheng MH,Feng B,Hu CY,et al. Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer[J].Minim Invasive Ther Allied Technol,2010,19(6):329-339. [15]Tang BQ, CampbellJL.Laparoscopic colon surgery in community practice[J].Am J Surg, 2007, 193(5):575-578. [16]Gerard JP,Azria D,Gourgou-Bourgade S,et al. Clinical outcome of the ACCORD 12/0405 PRODIGE 2randomized trial in rectal cancer[J].J Clin Oncol,2012,30(36):4558-4565.DOI:10.1200/JCO.2012.42.8771. [17]Minsky BD,Guillem JG,Multidisciplinary management of resectable rectal cancer,New developments and controversies[J].Oncology (Williston Park),2008,22(12):1430-1437. [18]Latkauskas T,Paskauskas S,Dambrauskas Z,et al,Preoperative chemoradiation vs. radiation alone for stage Ⅱ and Ⅲ resectable rectal cancer:a meta-analysis[J].Colorectal Dis,2010,12(11):1075-1083.DOI:10.1111/j.1463-1318.2009.02015.x. [19]Capirci C,Valentini V,Cionini L,et al. Prognostic value of pathologic complete response after neoadjuvant therapy inlocally advanced rectal cancer:long-term analysis of 566 ypCR patients[J].Int J Radiat Oncol Biol Phys,2008,72(1):99-107. [20]彭海花,游凯云,王成涛,等.局部晚期直肠癌新辅助放化疗术后病理分期对预后影响[J].中华放射肿瘤学杂志,2013,22(6):439-442.DOI:10.3760/cma.j.issn.1004-4221.2013.06.005. [21]彭海花,游凯云,王成涛,等.经直肠超声用于局部晚期直肠NeoCRT后再分期[J].中华胃肠外科杂志,2013,16(12):1203-1207.DOI:10.1093/gastro/got028. [22]游凯云,彭海花,高远红,等.局部晚期直肠癌术前新辅助放化疗后ypT1－4N0术后辅助化疗的价值[J].中华肿瘤杂志,2013,35(9):707-713.DOI:10.3760/cma.j.issn.0253-3766.2013.09.014. [23]Kai-yun Y,Huang R,Ding PR,et al. Selective use of adjuvant chemotherapy for rectal cancer patients with ypN0[J].Int J Colorectal Dis,2014,29(4):529-538.DOI:10.1007/s00384-014-1831-0. [24]O′Connell JB,Maggard MA,Ko CY.Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging[J].J Nat I Cancer Inst,2004,96(6):1420-1425.
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