Prognostic analysis of intensity modulated radiotherapy combined with TACE for hepatic metastasis of rectal cancer
Objective To explore the survival prognosis of rectal cancer patients with liver metastasis performed intensity modulated radiotherapy(IMRT)combined with transcatheter arterial chemoembolization(TACE).Methods From April 2019 to April 2020,a total of 120 rectal cancer patients with liver metastasis were enrolled,which included 70 males and 50 females,aged 44-67 years old with average age of 55.63 years old(standard deviation 8.56 years old);body mass index(BMI)was 19.34-25.89 kg/m2 with mean BMI of 22.20 kg/m2(standard deviation 1.80 kg/m2);49 cases of poorly differentiated rectal cancer and 71 of highly differentiated rectal cancer;maximum diameter of liver metastases was 0.78-5.65 cm with median maximum diameter of 3 cm(1-5 cm);numbers of tumor was 1-4 with mean numbers of 2.14(standard deviation 0.59);score of quality of life(QOL)questionnaire-colorectal cancer 38(QLQ-CR38)was 35-45 with mean score of 40.33(standard devia-tion 3.03 scores);73 cases of TNM stage Ⅰ and 47 of stage Ⅱ.According to Child-Pugh classification,there were 68 cases of grade A and 52 of grade B.There were 48 cases of rectal adenocarcinoma and 72 of squamous adenocarcinoma;28 cases of portal vein or inferior vena cava tumor thrombus;the Karnofsky Performance Status(KPS)score was 69-87 with mean score of 77.50(standard deviation 7.33 scores).All of them were divided into control group(n=60,performed TACE)and study group(n=60,performed IMRT combined with TACE)by random number table method.The therapeutic effects of 2 groups were compared and analyzed,the liver function and QOL before and after treatment were compared between 2 groups,and the adverse reactions were recorded.All of them were followed up for 3-year to record survival rates at each time point.Results The effec-tive rate of treatment in control group[50.00％(30/60)]was significantly lower than that in study group[76.67％(46/60)](P＜0.05).After treatment,the levels of prothrombin time(PT)and albumin(ALB)in 2 groups were both decreased,but there was no significant difference between 2 groups(P＞0.05).The levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)in 2 groups were higher than those before treatment,and study group was remarkably significantly higher than control group[(244.26±112.10)U/Lvs(90.25±12.45)U/L,(255.12±56.54)U/Lvs(90.45±15.26)U/L.P＜0.05].After treatment,KPS and QLQ-CR38 scale scores were increased,and study group was significantly higher than control group[(89.98±4.56)scores vs(82.11±3.46)scores,(72.41±4.18)scores vs(64.56±3.16)scores.P＜0.05].The mean dose of normal liver,spinal cord,stomach,left kidney and right kidney in study group were significantly higher than those in control group[(19.26±5.11)Gy vs(16.26±6.15)Gy,(8.36±2.12)Gy vs(1.23±0.54)Gy,(0.52±0.18)％vs(0.31±0.12)％,(4.88±0.51)％vs(2.12±0.12)％,(8.11±9.11)％vs(4.15±1.03)％.P＜0.05].There was no significant difference in incidence of adverse reactions such as gastrointestinal reaction,liver function injury,renal function injury,bone marrow suppression and peripheral neurotoxicity between 2 groups(P＞0.05).In addition,the survival rates of 1-year and 2-year after operation in study group were better than in control group(86.67％vs 68.33％,71.67％vs 53.33％.P＜0.05);but there was no significant difference in 3-year survival rate between 2 groups(P＞0.05).Conclusion It is demonstrated that IMRT combined with TACE in patients with liver metastasis of rectal cancer could improve treatment efficiency,increase 1-year and 2-year survival rate and QOL,and have positive impact on survival prognosis of pa-tients,but show certain damage to liver function in short term of treatment.
liver metastasis of rectal cancerintensity-modulated conformate radiotherapyhepatic artery chemoembolizationsurvival prognosis
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