直腸癌に対するネオアジュバント化学放射線療法後の長期的な経過観察データ

Long-term outcomes of real world 'watch and wait' data for rectal cancer after neoadjuvant chemoradiotherapy.

• G Simpson
• P Hopley
• J Wilson
• N Day
• A Haworth
• A Montazeri
• D Smith
• L Titu
• J Anderson
• D Agbamu
• C Walsh

抄録

AIM:

AIM: A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust.

方法:

METHODS: An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival.

結果:

我々は9年間で563例の直腸癌を診断した。そのうち283例が直腸切除術を受けた（50.3％）。MRIによる病期分類でマージンを脅かす腫瘍に対しては155例にNACRTが使用された。49人の患者（31.6％）がNACRT後10週目の評価（MRIと内視鏡検査）で「完全に近い」または完全臨床反応（cCR）を経験した。年齢中央値は69歳（範囲44～83歳）で、男女比は32：17であった。追跡期間中央値は38ヵ月（範囲12～96）であった。肛門縁からの腫瘍の距離の中央値は7cm（1-15cm）であった。22人の患者が初診時にcCRを有し、27人の患者が「ほぼ」cCRを有していた。ほぼ」cCRを経験した27人のうち、17人（63％）が再評価でcCRに進展し、10人（37％）がcCRに進展しなかった。これら10人の患者のうち、7人は標準的な外科的切除を受け、3人は手術に適していなかった。遅発性切除を行った7例のR0は100％であった。39人の患者（cCR 22人、cCRに進行した「近い」cCR 17人）（NACRTを受けた患者の25.2％）のうち、6人の患者が局所再生を経験した（15.4％）。局所再生までの期間の中央値は29ヵ月（15～60ヵ月）であった。この6例のうち1例はサルベージ腹腔鏡下切除術を受け、1例は接触放射線治療を勧められ、4例は手術に反対して接触放射線治療も受けた。全生存率は2年目で100％、5年目で90％であった。無病生存率は2年目で90.47％、5年目で74.8％であった。

RESULTS: We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years.

結論:

CONCLUSION: A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival.

Colorectal Disease © 2020 The Association of Coloproctology of Great Britain and Ireland.