Neoadjuvant Concurrent Chemoradiotherapy Might Not be Necessary for Stage III Upper-third Rectal Adenocarcinoma

對於第三期上位直腸癌的病患是否需要手術前放射線及化學治療

李明泓(Ming-Hung Lee) ； 王瑞和(Jui-Ho Wang) ； 金台明(Tai-Ming King) ； 張敏琪(Min-Chi Chang) ； 許詔文(Chao-Wen Hsu)

《中華民國大腸直腸外科醫學會雜誌》 28卷1期 (2017/03) Pp. 11-17

https://doi.org/10.6312/SCRSTW.2017.28(1).10518

摘要

Purpose. The necessity of neoadjuvant concurrent chemoradiotherapy in stage III upper-third rectal cancer patients has not yet been definitively proven. The aim of this study was to compare the oncological outcomes and clinical results of neoadjuvant concurrent chemoradiotherapy and primary radical surgery in upper-third rectal cancer patients. Methods. Between January 2004 and December 2012, we examined 222 pathological stage III rectal cancer patients. These patients were separated into two groups based on their treatment modality: the neoadjuvant concurrent chemoradiotherapy group and the primary radical surgery group. The clinicopathological and surgical data of the two groups were then collected and retrospectively analyzed. Results. In our study cohort, men were predominant in both groups. The mean age of all patients was 63.2 years. After a three-year follow-up period, no significant statistical differences were found in the local recurrence rate or cancer-specific survival. Based on the Kaplan-Meier curve, the p-values for local recurrence, distant metastasis, and cancer-specific survival were 0.526, 0.087, and 0.127, respectively. The complication rate for neoadjuvant concurrent chemoradiation therapy was 25.7% and 8% for primary radical surgery; the p-value was 0.002. The most common complications for patients were anastomotic leakage and rectovesical fistula. Conclusions. Based on our data, neoadjuvant concurrent chemoradiation therapy for stage III upper-third rectal tumors is not necessary. Both the clinical results and the long-term oncological outcomes indicated that there were no significant statistical differences between the two groups. However, a higher rate of complications was observed in the patients who received neoadjuvant concurrent chemoradiotherapy.

關鍵字

Upper-third rectal cancer ； Neoadjuvant chemoradiotherapy ； Adenocarcinima

並列摘要

目的 對於第三期上位直腸癌患者接受新輔助性同步電化療的必要性沒有明確的建議。這項研究的目的是要探討在第三期上位直腸癌在單一醫學中心比較腫瘤成果和新輔助同步放化療和先施行根治性手術的臨床效果。方法 從2004 年1 月至2012 年12 月，我們收集了222 位病理結果為第三期上位直腸癌的病人，分為兩組，分別給予新輔助性電化療然後行低前位切除手術及直接接受低前位切除術治療，回溯性收集相關臨床和病理資料併分析。結果 222 位病人中，新輔助性電化療組及先接受手術組皆以男性病患佔多數，平均年齡為63.2 歲，在追蹤至少三年以上，比較兩組的局部復發率，腫瘤特異性存活率Kaplan-Meier curve 的統計局部復發率p 值為0.526，遠端轉移率為p 值為0.087，整體存活率為p 值為0.127。在併發症上，新輔助性電化療組 (9/35) 比上先接受手術組(15/187) 發生併發症之機率p 值為0.002，在統計學上達到顯著之差異。主要以腸道吻合滲漏，直腸膀胱廔管為主。結論 在第三期上位直腸癌新輔助放化療同步治療是沒有必要的。臨床效果和長期的腫瘤學結果兩組間無顯著統計學差異。然而，在我們的研究中發現在新輔助同步電化療組併發症較多。

並列關鍵字

上位直腸癌 ； 新輔助放化療同步治療 ； 腺癌

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