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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: A prospective multicentre study
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Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: A prospective multicentre study

机译：不良反应者的术前放疗和直肠癌局部切除术及即时彻底再手术：一项前瞻性多中心研究

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Purpose: To assess local control after preoperative radiation and local excision and to determine an optimal radiotherapy regimen. Methods: Eighty-nine patients with G1-2 rectal adenocarcinoma <3-4 cm; unfavourable cT1N0 (23.6%), cT2N0 (62.9%) or borderline cT2/cT3N0 (13.5%) received 5 × 5 Gy plus 4 Gy boost (71.9%) or 55.8 Gy in 31 fractions with 5-FU and leucovorin (28.1%). Local excision (traditional technique 56.2%, transanal endoscopic microsurgery 41.6%, Kraske procedure 2.2%) was performed 6-8 weeks later. If patients were downstaged to ypT0-1 without unfavourable factors (good responders), this was deemed definitive treatment. Immediate conversion to radical surgery was recommended for remaining patients. Results: Good response to radiation was seen in 67.2% of patients in the short-course group and in 80.0% in the chemoradiation group, p = 0.30. Local recurrence at 2 years (median follow-up) in good responders was 11.8% in the short-course group and 6.2% in the chemoradiation group, p = 0.53. In the total group, a lower rate of local recurrence at 2 years was observed in elderly patients (>69 years, median value) when compared to the younger patients; 8.3% vs. 27.7%, Cox analysis hazard ratio 0.232, p = 0.016. A total of 18 patients initially managed with local excision required conversion to abdominal surgery but either refused it or were unfit. In this group, local recurrence at 2 years was 37.1%. Conclusions: This study suggests an acceptable local recurrence rate after preoperative radiotherapy and local excision of small, radiosensitive tumours in elderly patients.
机译：目的：评估术前放疗和局部切除后的局部控制，并确定最佳的放疗方案。方法：89例G1-2直肠腺癌<3-4 cm的患者;不利的cT1N0（23.6％），cT2N0（62.9％）或临界cT2 / cT3N0（13.5％）在31馏分中分别接受5×5 Gy加4 Gy升压（71.9％）或55.8 Gy，其中含有5-FU和亚叶酸（28.1％） 。 6-8周后进行局部切除（传统技术为56.2％，经肛门内窥镜显微手术为41.6％，Kraske手术为2.2％）。如果患者在无不利因素的情况下降级到ypT0-1（良好的应答者），则被认为是确定的治疗方法。对于其余患者，建议立即改用根治性手术。结果：短疗程组中有67.2％的患者对放射线反应良好，化学放疗组中80.0％的患者对放射线反应良好，p = 0.30。短疗程组在2年（中位随访）良好反应者中的局部复发率为11.8％，化学放疗组为6.2％，p = 0.53。在整个组中，与年轻患者相比，老年患者在2年时的局部复发率较低（> 69岁，中位数）。 8.3％和27.7％，Cox分析风险比0.232，p = 0.016。最初接受局部切除术的总共18例患者需要转换为腹部手术，但拒绝手术或不适合。在该组中，2年局部复发率为37.1％。结论：这项研究表明老年患者术前放疗和局部切除细小的放射敏感性肿瘤后局部复发率可以接受。

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