The effect of local excision and adjuvant radiotherapy for patients with stage Ⅰ rectal cancer

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Author:
XIAO Qin(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
LIU Xin-fan(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
YU Zi-hao(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
JIN Jing(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
LI Ye-xiong(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
WANG Shu-lian(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
WANG Wei-hu(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
SONG Yong-wen(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
LIU Yue-ping(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
REN Hua(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
FANG Hui(Department of Radiation Oncology, Cancer Hospital(Institute),Chinese Academy of Medical Sciences, Pecking Union Medical College, Beijing 100021, China)
Journal Title:
Chinese Journal of Radiation Oncology
Issue:
Volume 21, Issue 05, 2012
DOI:
10.3760/cma.j.issn.1004-4221.2012.05.015
Key Word:
Rectal neoplasms/surgery;Rectal neoplasms/radiotherapy;Prognosis

Abstract: Objective To evaluate the long-term survival and treatment failure patterns for patients with stage Ⅰ adenocarcinoma in the lower rectum after local excision with or without adjuvant radiotherapy.Methods From Jan.2000 to Dec.2008,Seventy-seven patients with rectal cancer received local excision.Among them,41 received adjuvant radiotherapy.Fifty-four patients were pathologically proven as T1,the other 23 as T2.Patients were classified into low-and high-risk groups according to tumor grade,the length of tumor,surgical margin,circumference ratio of tumor/rectum and T stage.Survival rates and prognostic factors were estimated by Kaplan-Meier method,and comparisons were made by the Logrank test.Results Fourty patients were followed up more than 5 years.The 5-year locoregional recurrence-free survival (LRFS)and overall survival (OS) rates were 83% and 82% for the whole group.There were no significant differences in 5-year LRFS and OS rates in low-risk patients between local excision alone and local excision followed by adjuvant radiotherapy ( 86% ∶ 83%,x2 =0.29,P =0.588 and 100% ∶ 100%,x2 =1.50,P =0.221 ).In high-risk patients,the 5-year LRFS were similar (80% ∶ 82%,x2 =0.27,P =0.600),but the OS were significantly different (92%∶ 66%,x2 =4.64,P =0.031 ) between local excision alone and local excision followed by adjuvant radiotherapy.By univariate analysis,large tumor size,positive margin,poor differentiation,tumor located less than 5 cm from anal verge and pT2 stage were poor prognostic factors for OS.The overall relapse rate for the whole group was 29%,and 70% of them were locoregional relapse.The 5-year OS for patients treated with radical salvage surgery after local relapse was 69%.Conclusions For stage Ⅰ lower-sited rectal cancer,low-risk patients can achieve good result after local excision alone.The role of adjuvant radiotherapy in high-risk patients needs further evaluation.Local relapse is the main cause of failure,and salvage surgery after local relapse can provide long-term survival.

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