Short-course Preoperative Radiotherapy with Delayed Surgery for Locally Advanced Rectal Cancer
CL Chiang, FAS Lee, YW Wong, CM Poon, CKK Choi, FCS Wong, WK Sze, SY Tung
Hong Kong J Radiol 2017;20:312-7
DOI: 10.12809/hkjr1716844
Objectives: To review the outcome of patients with locally advanced rectal cancer who underwent short-course preoperative radiotherapy (SCPRT) with delayed total mesorectal excision.
Methods: Consecutive patients with locally advanced rectal cancer who underwent SCPRT with delayed surgery between January 2011 and November 2014 in Tuen Mun Hospital were retrospectively reviewed.
Results: Overall, 18 men and five women aged 36 to 88 years underwent SCPRT with delayed surgery owing to advanced age (n = 10), poor performance status (n = 7), and severe comorbidity (n = 6). All patients had at least one risk factor: threatened mesorectal fascia (n = 20), tumour stage 4 (n = 4), lymph node stage 2 (n = 7), and low-lying tumour (n = 5). After SCPRT, 19 of the 23 patients underwent anterior resection (n = 13) or abdominal-perianal
resection (n = 6) at a median of 11 weeks and achieved R0 (n = 17) or R1 (n = 2) resection. During a median follow-up of 13 months, eight patients died due to metastasis (n = 5), medical condition without evidence of progression (n = 2), or postoperative complications (n = 1). The median survival time of the 23 patients was 34 months. The 1-year overall survival was 75.1%; the 1-year cancer-specific survival was 82.5%; and the 1-year progression-free survival was 79.3%. In 19 patients who underwent resection, six developed metastatic disease.
Two patients had local recurrence who also had synchronous distant metastasis. All patients completed SCPRT without interruption. Two patients had grade 3 or above toxicity: one had perforated bowel requiring emergency operation at 3 weeks and another had grade 3 leukopenia without evidence of sepsis. In the postoperative period (≤30 days), eight patients developed surgical complications including anastomotic leakage (n = 2), septic complications (n = 3), persistent perianal infection (n = 1), and ileus (n = 2). One patient died at postoperative
day 12 due to myocardial infarction. One patient developed severe late radiotherapy-related toxicity of burst stump and pelvic abscess at 5 months.
Conclusion: SCPRT with delayed surgery can downsize and downstage locally advanced rectal cancer and achieve a favourable toxicity profile. It is a viable option for patients who are unfit for preoperative long-course chemoradiotherapy.
Authors' affiliations:
CL Chiang1, FAS Lee1, YW Wong2, CM Poon2, CKK Choi1, FCS Wong1, WK Sze1, SY Tung1
1Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
2Department of Surgery, Tuen Mun Hospital, Tuen Mun, Hong Kong
中文摘要
術前短期放療與延遲手術治療局部晚期直腸癌
蔣子樑、李安誠、黃耀華、潘志明、蔡國強、黃志成、施永健、董煜
目的：回顧接受短期術前放療（SCPRT）與延遲全直腸切除術的局部晚期直腸癌的患者的治療結果。
方法：回顧分析2011年1月至2014年11月間，在屯門醫院接受SCPRT與延遲手術的局部晚期直腸癌的連續患者。
結果：18例男性和5例女性年齡36至88歲，因高齡（n = 10）、一般情況差（n = 7）和嚴重合併症（n = 6）接受SCPRT與延遲手術治療局部晚期直腸癌。所有患者至少有一項危險因素：直腸內筋膜受侵（n = 20）、腫瘤4期（n = 4）、淋巴結2期（n = 7）和低位腫瘤（n = 5）。23例患者中，19例在SCPRT後中位數11週進行了前切除術（n = 13）或腹部 – 肛門切除術（n = 6），並達到R0（n = 17）或R1（n = 2）切除。在13個月的中位隨訪期間，8名患者因轉移（n = 5）、非腫瘤進展醫療情況（n = 2）或術後併發症（n = 1）而死亡。23例患者的中位生存時間為34個月。1年整體生存率為75.1%；1年癌症特異生存率為82.5﹪；1年無進展生存率為79.3﹪。在19例接受切除的患者中，6例發生轉移。兩名患者局部復發同時出現遠處轉移。所有患者不間斷地完成SCPRT。兩名患者發生3級或以上的放療毒性：一名發生腸穿孔並需要在3週時進行緊急手術，另一名發生3級白細胞減少症，但無膿毒症。在術後期間（≤30天），8例患者發生手術併發症，包括吻合口漏（n = 2）、膿毒性併發症（n = 3）、持續性肛門周圍感染（n = 1）和腸梗阻（n = 2）。一名患者術後第12天因心肌梗死死亡。一名患者5個月後出現了嚴重的晚期放療相關毒性，包括殘端破裂和盆腔膿腫。
結論：對局部晚期直腸癌患者，SCPRT與延遲手術可以縮小腫瘤並降期以及耐受性好。對於不適合長期術前放化療的患者而言，是一個可行的選擇。