Locally advanced rectal cancer requires a multimodal treatment. Radiotherapy is being explored for intensification to improve the rates of pathological complete responses (ypCR rates) which are correlated with better outcomes. This study reports a comparison between standard versus escalated doses in a preoperative scenario. The ypCR rates, toxicity, postoperative complications, and disease-free and overall survival at 5 years are described. From 2012 to 2019, 99 patients were analyzed retrospectively: standard arm (mean of 47.5 Gy) vs. dose-escalated arm (mean of 54.3 Gy). All patients were treated with 3DRT in 25 fractions, with concomitant capecitabine and surgery performed according to the total mesorectal excision principles in both arms. The ypCR was reported using the “College of American Pathologist grades”; the gastrointestinal (GI) and genitourinary (GU) toxicity was reported using the “Common Terminology Criteria for Adverse Events” (CTCAE 4.0). The ypCR rates were higher in the dose-escalated group (25% vs. 10.64%;p= 0.07), with a lower rate of non-treatment response (61.36% vs. 38.64%;p= 0.11). No statistical differences between the arms were found in terms of the oncological outcomes, postoperative complications (p= 0.15), second surgeries (p= 0.62), or deaths (p= 0.62). The CTCAE acute GI and GU toxicity were grade I or II in both arms. Our study presents a long-term follow-up in comparative cohorts.
局部进展期直肠癌需要多模式综合治疗。为提升与良好预后相关的病理完全缓解率，放疗剂量强化策略正被积极探索。本研究比较了术前标准剂量与强化剂量方案的疗效差异，重点分析病理完全缓解率、毒性反应、术后并发症以及5年无病生存率和总生存率。2012年至2019年间，我们回顾性分析了99例患者数据：标准剂量组（平均47.5 Gy）与剂量强化组（平均54.3 Gy）。所有患者均接受25次三维适形放疗，同步口服卡培他滨化疗，并遵循全直肠系膜切除原则进行手术。病理完全缓解评估采用美国病理学家学会分级标准；胃肠道与泌尿生殖系统毒性反应依据不良事件通用术语标准（CTCAE 4.0）进行评价。剂量强化组病理完全缓解率更高（25% vs. 10.64%；p=0.07），治疗无应答率更低（61.36% vs. 38.64%；p=0.11）。两组在肿瘤学结局、术后并发症（p=0.15）、二次手术率（p=0.62）及死亡率（p=0.62）方面均无统计学差异。两组CTCAE急性胃肠道与泌尿生殖系统毒性反应均限于Ⅰ-Ⅱ级。本研究通过长期随访对比，为临床决策提供了重要参考依据。
肿瘤(癌症)患者之家