- 期刊
Long-term Outcomes in Rectal Cancer Patients with Clinical Complete Response after Concurrent Chemoradiotherapy: A Local Hospital Experience
同步放射及化學治療後達到臨床完全緩解的直腸癌患者之預後：區域醫院的經驗分享
摘要
Purpose. Multimodality treatment for rectal cancer is associated with improved long-term functional outcomes and quality of life. Of the available systemic and locoregional treatments, total neoadjuvant therapy is promising. Our aim here is to share our experience with organ-preservation strategies, evaluate the oncologic outcomes of our patients, and recommend an alternative treatment strategy for patients who refuse surgery. Methods. We included patients diagnosed with malignant neoplasm of the rectum who underwent neoadjuvant chemoradiotherapy between 1 November 2004 and 31 October 2019. We used digital rectal examination (DRE), carcinoembryonic antigen (CEA) levels, scope with biopsy, computed tomography (CT), and chest X-ray for identification and restaging. Clinical complete response (cCR) was defined as the absence of any residual viable cancer or scars after two months of surveillance. The primary endpoint was any local regrowth of rectal cancer at the tumor site or in regional lymph nodes. Secondary endpoints were incidence of distant metastasis, overall survival, and disease-specific survival or toxicity. Results. The median age was 68.3 years and median follow-up time was 5 years. No patient had local regrowth. Distant metastases in the lungs were diagnosed in one patient in the third year after diagnosis, in the brain was diagnosed in one patient in the second year after diagnosis. Two patients died due to upper gastrointestinal bleeding and septic shock. The five-year overall survival and disease-free survival rates were 69% and 84%, respectively. Conclusion. Despite some patients receiving unsystematic chemo-radiotherapy regimens, their oncologic outcomes were promising. We conclude that ＂watch-and-wait＂ is an effective treatment for low rectal cancer patients who refuse surgery, but highlight the importance of surveillance.
並列摘要
目的：直腸癌的多模式治療與改善長期器官功能及生活品質有關。在目前可用的全身性和局部性治療，研究顯示接受前導性放化療後的直腸癌病人，只有大約1/4的病人復發，而且幾乎都是兩年內局部復發，整體五年生存率有85%。本研究的目的是分享我們的經驗，評估接受“觀察與等待＂的患者的長期預後，並為拒絕手術的患者提供替代治療。方法：我們納入了2004年11月1日至2019年10月31日期間接受過前導性放化療的直腸惡性腫瘤患者。我們使用了肛門指診（DRE）、癌胚抗原（CEA）指數，大腸鏡、活體組織切片、斷層掃描（CT）和胸部X光片來診斷及分期。臨床完全緩解（cCR）定義為在監測兩個月後不存在任何殘留的腫瘤或疤痕。我們評估了在腫瘤部位或區域淋巴結中是否有局部復發、遠處轉移的發生率，整體存活率、無疾病存活期及放化療副作用。結果：病人平均年齡為68.3歲，平均追蹤時間為5年。沒有病患出現局部復發。一名患者在診斷後第三年診斷出肺遠處轉移，另一名患者在診斷後第二年診斷出腦遠處轉移。兩名病患因上消化道出血和敗血性休克死亡。五年總生存率和無病生存率分別為69%和84%。結論：儘管部分年代較久遠的病人接受了不同劑量的放射及化學治療，但其預後還是與當前的研究不相上下。我們認為“等待及觀察＂這個策略對於拒絕手術的低位直腸癌患者是一種有效的治療方法，但治療後的追蹤扮演了很重要的角色。
參考文獻
延伸閱讀
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