Pathologic Response, When Increased by Longer Interval, Is a Marker but Not the Cause of Good Prognosis in Rectal Cancer: 17-year Follow-up of the Lyon R90-01 Randomized Trial

被引:46
作者
Cotte, Eddy [1 ,2 ]
Passot, Guillaume [1 ,2 ]
Decullier, Evelyne [3 ]
Maurice, Christelle [3 ]
Glehen, Olivier [1 ,2 ]
Francois, Yves [1 ,2 ]
Lorchel, Fabrice [4 ]
Chapet, Olivier [4 ]
Gerard, Jean-Pierre [5 ]
机构
[1] Hosp Civils Lyon, Ctr Hosp Lyon Sud, Dept Digest Surg, Pierre Benite, France
[2] Lyon Sud Charles Merieux Med Univ, EMR 3738, Univ Lyon 1, Oullins, France
[3] Hosp Civils Lyon, Pole IMER, Lyon, France
[4] Hosp Civils Lyon, Ctr Hosp Lyon Sud, Dept Radiotherapy, Pierre Benite, France
[5] Univ Nice Sophia, Ctr Antoine Lacassagne, Dept Radiotherapy, Nice, France
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2016年 / 94卷 / 03期
关键词
TOTAL MESORECTAL EXCISION; PHASE-III TRIAL; PREOPERATIVE RADIOTHERAPY; NEOADJUVANT CHEMORADIATION; LOCAL RECURRENCE; CLINICAL-TRIAL; CHEMORADIOTHERAPY; SPHINCTER; THERAPY; SURGERY;
D O I
10.1016/j.ijrobp.2015.10.061
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The Lyon R90-01 randomized trial investigated whether the interval between preoperative radiation therapy and surgery influenced rectal cancer outcome. Long-term results are reported here after a median follow-up of 17 years. Methods and Materials: Between February 1991 and December 1995, 210 patients from 29 French centers were randomly assigned (ratio of 1: 1) to groups that waited either 2 weeks (short interval [SI]) or 6 to 8 weeks (long interval [LI]) between neoadjuvant radiation therapy and surgery. The primary endpoint was sphincter-preserving surgery. Results: LI group showed a better pathologic response (complete response or few residual cells) after radiation therapy than the SI group (26% vs 10.3%, P=.015). A better pathologic response was associated in multivariate analysis with significant improvement of overall survival (pT: P=.0293 and pN: P=.0048) but it was irrespective of the interval duration. The median follow-up was 17.2 years. The 5-, 10-, 15-, and 17-year overall survival rates were, respectively, 66.8%, 48.7%, 40.0%, and 34.0% for the SI group and, respectively, 67.1%, 53.5%, 41.9%, and 34.0% for the LI group. There were no significant differences between groups in terms of survival (P=. 7656) or local recurrence rates (SI: 14.4% vs LI: 12.1%, respectively; P=. 6202). Of 24 local disease recurrences, 20 (83%) occurred during the first 2 postoperative years, and all but one (96%) occurred during the first 5 postoperative years. The rate of second new malignancies was 9.4% (19 patients). Conclusions: The radiation-induced sterilization rate of the preoperative cancer specimen was a marker of good prognosis. The interval duration (the treatment being the same) although it is modifying the sterilization rate has no impact on survival. Radiation therapy did not postpone local recurrence, because the rate of local relapse after 5 years was low. Radiation-induced cancers after radiation therapy were unusual and should not influence treatment decisions in adults. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:544 / 553
页数:10
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