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在新辅助剂长期化疗或放射治疗和短期放射治疗后,器官的保存
概括
与短疗程放射治疗 (SCRT) 相比,在总新辅助疗法 (TNT) 中的长期化疗放射治疗 (LCCRT) 表明,与观察和等待治疗的直肠癌患者相比,器官的保存优越,局部再生减少. 两种疗法都显示出相似的生存结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 在直肠癌治疗中,器官的保存是关键目标.
- 整体新辅助疗法 (TNT) 整合了手术前的化疗和放射治疗.
- 基于LCCRT和基于SCRT的TNT之间的器官保存差异还没有得到很好的定义.
研究的目的:
- 为了比较基于LCCRT和基于SCRT的TNT疗法之间的器官保存率.
- 评估直肠癌患者的局部再生,远程复发,无疾病生存率 (DFS) 和整体生存率 (OS).
- 为寻求器官保存的患者确定最佳的TNT治疗方案.
主要方法:
- 一个自然实验比较LCCRT和SCRT在323位局部晚期直肠腺癌患者.
- 实现临床完整反应的患者使用观察和等待 (WW) 进行管理.
- 主要结局是器官保存2年;次要结局包括局部再生,复发,DFS和OS.
主要成果:
- 类似的临床完整响应率 (44.5%的LCCRT与43.4%的SCRT).
- 通过LCCRT (40%) 与SCRT (31%) 总体而言,器官保存时间在2年内更高.
- 在WW患者中,与SCRT相比,LCCRT显示了较高的2年器官保存 (89%vs70%) 和较低的局部再生 (19%vs36%).
结论:
- 诱导LCCRT之后的巩固化疗是TNT在局部晚期直肠癌中首选的.
- 基于LCCRT的TNT在战后患者中提供了改善的器官保存和局部控制.
- 基于LCCRT和SCRT的TNT都表现出类似的长期生存结果 (DFS和OS).
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