Abdominal Tumor
Mid-term outcomes of a prospective phase Ⅱ trial of preoperative sandwich-like neoadjuvant chemoradiotherapy for locally advanced rectal cancer
Jiawang Wei, Rong Zhang, Weiwei Xiao, Xin Yu, Suping Guo, Zhifan Zeng, Gong Chen, Zhizhong Pan, Desen Wan, Peirong Ding, Yuanhong Gao
Published 2017-07-15
Cite as Chin J Radiat Oncol, 2017, 26(7): 759-762. DOI: 10.3760/cma.j.issn.1004-4221.2017.07.008
Abstract
ObjectiveTo evaluate the mid-to long-term survival benefits of preoperative sandwich-like neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC).
MethodsA total of 45 LARC patients who underwent neoadjuvant sandwich CRT in the form of XELOX regimen prior to, concurrently with, and following volumetric modulated arc radiotherapy (VMAT) in 2012 were enrolled in this study. VMAT was given at a gross tumor volume dose of 50 Gy in 25 fractions, and a clinical target volume dose of 45-46 Gy in 25 fractions. Total mesorectal excision was performed 6 to 8 weeks after completion of VMAT.The overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method, and survival comparison and univariate prognostic analysis were performed using the log-rank test.
ResultsThe median follow-up time was 46.7 months. There was no local recurrence detected among the patients. The 3-year distant metastasis (DM) rate was 18%, and the 3-year OS and DFS were 96% and 84%, respectively. Univariate analysis indicated that perineural invasion, N1-N2 pathology (pathological stage Ⅲ), and Ca-199>35 U/ml before treatment were risk factors for DM (P=0.000, 0.000, and 0.013, respectively).
ConclusionsThe significant short-term efficacy of preoperative sandwich-like neoadjuvant CRT can be extended to a positive mid-term survival in LARC patients. However, further phase Ⅲ clinical studies will be needed to confirm this finding.
Key words:
Rectal neoplasms/chemoradiotherapy; Chemoradiotherapy, neoadjuvant; Prognosis
Contributor Information
Jiawang Wei
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Rong Zhang
Department of Endoscopic Laser, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Weiwei Xiao
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Xin Yu
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Suping Guo
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Zhifan Zeng
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Gong Chen
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Zhizhong Pan
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Desen Wan
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Peirong Ding
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
Yuanhong Gao
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
