Prolonging the Interval between Neoadjuvant Concurrent Chemoradiotherapy and Surgery Improves Pathological Outcomes in Rectal Cancer

延長直腸癌前導性化放療至手術前的間隔增進病理結果

鄭功全(Kung-Chuan Cheng) ； 陳鴻華(Hong-Hwa Chen) ； 張家駱(Chia-Lo Chang) ； 胡萬祥(Wan-Hsiang Hu) ； 李克釗(Ko-Chao Lee) ； 蔡鎧隆(Kai-Lung Tsai) ； 林岳民(Yueh-Ming Lin) ； 黃英彥(Eng-Yen Huang) ； 許軒之(Hsuan-Chih Hsu) ； 盧建璋(Chien-Chang Lu)

《中華民國大腸直腸外科醫學會雜誌》 27卷3期 (2016/09) Pp. 119-126

https://doi.org/10.6312/SCRSTW.2016.27(3).10507

摘要

目的術前的前導性合併化學及放射線治療加上根治性手術已經是目前對於局部侵犯的直腸癌中的標準治療。然而，在前導性合併化學及放射線與手術之間需間隔多久目前仍具爭議性。這篇回溯性分析的目的是展現延長前導治療與手術之間的間隔對術後病理結果的影響。方法自2010年二月到2014年八月為止，共85位接受過前導性化學放射治療及根治性手術的直腸癌病人被涵括入這項研究。治療前臨床TNM分期、放射治療結束到手術的時間、手術方式，以及術後病理分期都被收集與分析。結果根據放射治療結束與根治性手術之間的間隔長度，85位病患分成兩組：短間隔組(＜10週，n＝54)以及長間隔組(≧10週，n＝31)。病人特種、治療前分期，及手術方式兩組間無特別差異。在接近病理完全反應率(ypT0-1N0)方面長間隔組明顯優於短間隔組(45.2% versus 22.2%, p=0.049)。結論拉長前導性放射化學治療與根治性手術之間的間隔似乎能增進病理結果。長間隔組的接近病理完全反應率明顯提高。

關鍵字

直腸癌 ； 前導性化學放射治療 ； 手術間隔 ； 病理結果

並列摘要

Purpose. Preoperative neoadjuvant concurrent chemoradiotherapy (CCRT) followed by a radical operation has become a standard procedure for locally advanced low rectal cancer. However, the optimal interval between the end of neoadjuvant CCRT and the operation is still controversial. This retrospective analysis is aimed to demonstrate the impact of prolonging this interval on pathological outcomes. Methods. Eighty-five patients with locally advanced rectal cancer who had undergone neoadjuvant CCRT followed by surgical interventions between 2010 Feb to 2014 Aug were included. Data on clinical TNM stage before treatment, interval between neoadjuvant therapy and surgery, type of surgery, and final pathologic stage were collected and analyzed. Results. Patients were divided into two groups according to the interval between neoadjuvant therapy and surgery: shorter interval group (＜ 10 weeks, n = 54 ), and longer interval group (≧ 10 weeks, n = 38 ). There was no significant difference in demographics, TNM stage before treatment, and type of surgery between these 2 groups. The group with longer intervalshad significantly higher nearly pathological complete response (22.2% vs.45.2%, p = 0.049). Conclusion. Longer interval (≧ 10 wks) between the end of neoadjuvant CCRT and surgery seems to improve the pathologic outcomes. The nearly complete response rate was significantly higher in the longer interval group.

並列關鍵字

Rectal cancer ； Neoadjuvant chemoradiotherapy ； Interval ； Pathological outcomes

參考文獻

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