Treatment Outcomes of Two Different Pre-Operative Modalities for Patients with Rectal Cancer: A Retrospective Study and the Importance of Major Surgery

在直腸癌病患比較兩種術前輔助治療結果：回溯性研究及探討進行標準手術之重要性

林士敏(Shih-Min Lin) ； 林信吟(Shinn-Yn Lin) ； 洪志宏(Ji-Hong Hong) ； 曾雁明(Ngan-Ming Tsang)

《放射治療與腫瘤學》 19卷1期 (2012/03) Pp. 1-9

https://doi.org/10.6316/TRO/201219(1)1

摘要

Purpose: The aim of the present study was to evaluate the incidence of complete tumor response (CR) achieved following two different neoadjuvant modalities and the importance of major surgery after neoadjuvant treatment. Materials and Method: Between March 1999 and December 2007, this is retrospective study included 417 patients with newly-diagnosed dissemination-naive rectal cancer, treated with pre-operative short-course radiotherapy (RT) or long-course chemoradiotherapy (CCRT). The status of tumor response was confirmed by biopsy or surgery. Result: Median follow-up was 30.9 months. After neoadjuvant treatment, CR was documented in 5 of 221 patients (2%) in the short-course RT group, and 34 of 198 (17%) in the long-course CCRT group (p ＜ 0.001). The 5-year overall survival rate was 59% in short-course RT group and 49% in long-course CCRT group respectively. Focusing on the subgroup that was documented to achieve pathological tumor complete response (pCR), the survival benefit was most clear in those who received major surgery after neoadjuvant treatment rather than local excision only. There were more patients receiving merely local excision or observation in CCRT group (n= 50, 25.5%) than in RT alone group (n= 7, 3%). In the subgroup analysis specific to the patients who underwent standard major surgery after neoadjuvant treatment, no statistically significant difference in terms of overall survival was found between these two different neoadjuvant settings (p= 0.657). Conclusions: Subgroup analysis pertaining to patients who actually received major surgery after neoadjuvant treatment showed that there was no significant difference with regard to overall survival rates in these two neoadjuvant settings. The importance of patient compliance and performing major surgery after neoadjuvant treatment was clearly demonstrated in this retrospective study.

關鍵字

完全緩解 ； 標準手術 ； 術前輔助治療 ； 直腸癌

並列摘要

Purpose: The aim of the present study was to evaluate the incidence of complete tumor response (CR) achieved following two different neoadjuvant modalities and the importance of major surgery after neoadjuvant treatment. Materials and Method: Between March 1999 and December 2007, this is retrospective study included 417 patients with newly-diagnosed dissemination-naive rectal cancer, treated with pre-operative short-course radiotherapy (RT) or long-course chemoradiotherapy (CCRT). The status of tumor response was confirmed by biopsy or surgery. Result: Median follow-up was 30.9 months. After neoadjuvant treatment, CR was documented in 5 of 221 patients (2%) in the short-course RT group, and 34 of 198 (17%) in the long-course CCRT group (p ＜ 0.001). The 5-year overall survival rate was 59% in short-course RT group and 49% in long-course CCRT group respectively. Focusing on the subgroup that was documented to achieve pathological tumor complete response (pCR), the survival benefit was most clear in those who received major surgery after neoadjuvant treatment rather than local excision only. There were more patients receiving merely local excision or observation in CCRT group (n= 50, 25.5%) than in RT alone group (n= 7, 3%). In the subgroup analysis specific to the patients who underwent standard major surgery after neoadjuvant treatment, no statistically significant difference in terms of overall survival was found between these two different neoadjuvant settings (p= 0.657). Conclusions: Subgroup analysis pertaining to patients who actually received major surgery after neoadjuvant treatment showed that there was no significant difference with regard to overall survival rates in these two neoadjuvant settings. The importance of patient compliance and performing major surgery after neoadjuvant treatment was clearly demonstrated in this retrospective study.

並列關鍵字

Complete tumor response ； Major surgery ； Pre-operative ； Rectal cancer