Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center
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Tarih
2015
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Rektum kanserinin tedavisinde tek başına standart cerrahi tedavi lokal rekürrens oranını %20'nin altına düşürememektedir. Bu nedenle birçok merkez lokal rekürrensi önlemek için eşzamanlı kemoterapiyle birlikte veya tek başına neoadjuvan radyoterapi (preop RTx) uygulamaktadır. Bu çalışmada, cerrahi ardından adjuvan kemoradyoterapi (Grup A) alan ve neoadjuvan kemoradyoterapiyi takiben cerrahi uygulanan (Grup NA) orta ve distal rektum kanserli 164 ardışık hastanın sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmada TNM evreleme sistemi olarak bilinen Amerikan Kanser Ortak Komitesi'nin (AJCC) evreleme sistemi kullanıldı. Radyolojik evre 1 (sadece T2N0M0) ile evre 3C (T4bN1-2M0) olarak değerlendirilen ve patolojik olarak R0 rezeksiyon uygulanan hastalar çalışmaya alındı. Cerrahi yöntem olarak total mezorektal eksizyon (TME) uygulandı. Radyoterapi günlük fraksiyone 180 cGy dozda 28 ardışık günde verildi. Kemoterapi; 5-fluorourasil (450 mg/m2/d) ve leucovorin (20 mg/m2/d) bolus olarak 1 ile 5. günler arası ve 29 ile 33. günler arası uygulandı.Bulgular: Grup NA'da 9 hastada (%13) patolojik tam yanıt (pCR) elde edildi. Grup NA ve Grup A'da, lokorejyonel rekürrens oranları sırasıyla %6,7 ve %30,8 idi (p<0,001), ortalama lokorejyonel rekürrenssiz sağkalım sırasıyla 190,0±7,3 ay ve 148,0±11,7 ay idi (p=0,002) ve ortalama sağkalım sırasıyla 119,2±15,3 ay ve 103,0±9,4 ay idi (p=0,23). Lokorejyonel rekürrens yönünden 0,92 istatistiksel güç ile anlamlılık elde edildi. Çalışmanın sekonder sonlanımı olan hastalıksız sağkalım ve genel sağkalım yönünden anlamlı bir fark bulunmadı. Sonuç: Neoadjuvan kemoradiyoterapi ile birlikte TME, özellikle MRI-Evre 2A ve 3C distal 2/3 rektal adenokarsinomalar için etkili bir tedavi protokolüdür. Klinik olarak T2N0M0 hastaların önemli bir bölümünde patolojik tam yanıt elde edildi, bu nedenle bu tedavi yöntemi daha ileri çalışmalar için temel oluşturabilir
Objective: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. in this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented.Material and Methods: the staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. the surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemotherapy comprised 5-fluorouracil (450 mg/m2/d) and leucovorin (20 mg/m2/d) bolus at days 1-5 and 29-33.Results: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). in Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met.Conclusion: Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies
Objective: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. in this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented.Material and Methods: the staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. the surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemotherapy comprised 5-fluorouracil (450 mg/m2/d) and leucovorin (20 mg/m2/d) bolus at days 1-5 and 29-33.Results: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). in Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met.Conclusion: Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Ulusal Cerrahi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
31
Sayı
4
