在直肠癌中适应风险的新辅助化学放射治疗:OCUM研究的最终报告
Reinhard Ruppert1, Theodor Junginger2, Rainer Kube3
1Department of General and Visceral Surgery, Endocrine Surgery, and Coloproctology, Municipal Hospital of Munich-Neuperlach, Munich, Germany.
概括
对直肠癌的新辅助化学放射治疗 (nCRT) 最好保留给高风险患者. 低风险患者可以安全地接受前期手术,避免不必要的nCRT并改善结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 辐射疗法 辐射疗法
背景情况:
- 结直肠癌的治疗通常涉及新辅助化疗或放射治疗 (nCRT),以减少局部区域性复发 (LR).
- 确定从nCRT中获益最多的患者对于优化治疗策略和最大限度地减少毒性至关重要.
- 基于瘤与中直肠护膜的距离的风险分层是治疗决策的关键因素.
研究的目的:
- 评估直肠癌的新辅助化学放射治疗 (nCRT) 是否可以仅限于高风险患者.
- 确定将nCRT限制在高危人群中是否会影响瘤学结果.
- 评估前期手术与nCRT的安全性和有效性,然后根据风险分层进行手术.
主要方法:
- 一项前性多中心干预研究,涉及1099名直肠癌患者 (cT2-4,任何cN,cM0).
- 患者被分为低风险 (大肠隔膜膜距离>1毫米) 和高风险 (距离≤1毫米和/或特定瘤特征) 两类.
- 治疗手臂包括低风险患者的前期全腹膜切除术 (TME) 和高风险患者的nCRT,其次是高风险患者的TME,主要终点为5年LR率.
主要成果:
- 根据协议治疗的884名患者中,530人 (60%) 接受了前期手术,354人 (40%) 接受了nCRT.
- 在前期手术后的5年LR率为2.9%,在nCRT后为5.7%.
- 高风险患者 (n=271) 显示出最糟糕的结果,五年LR率为5.9%,远程转移率为34.5%.
结论:
- 在低风险的直肠癌患者中,可以安全地省略新辅助化学放射治疗 (nCRT).
- 前置手术是低风险直肠癌患者的可行选择,可以达到有利的瘤结果.
- 高风险的直肠癌患者可能需要加强新辅助疗法以改善他们的预后.
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