Effect and safety of preoperative short-course radiotherapy combined with neoadjuvant chemotherapy for elderly patients with locally advanced rectal cancer
Objective To assess the impact of preoperative short-course radiotherapy combined with neoadjuvant chemotherapy on elderly patients with locally advanced rectal cancer after a 2-year follow-up.Methods In this retrospective cohort study,we included 446 consecutive cases of elderly patients diagnosed and treated for locally advanced rectal cancer(stage Ⅱ-Ⅲ with T3-T4 and/or positive regional lymph nodes)at the First People's Hospital of Shangqiu city from January 2012 to December 2019.The patients were divided into two groups based on the treatment method:an observation group(107 cases)and a control group(339 cases).The patients in the observation group underwent preoperative short-course radiotherapy combined with neoadjuvant chemotherapy.The regimen included short-term radiotherapy(25 Gy over 1 week in 5 fractions)followed by 4 courses of chemotherapy(CAPOX regimen).On the other hand,the control group received concurrent radiotherapy and chemotherapy.The regimen involved 50 Gy over 5 weeks in 25 fractions and concurrent capecitabine chemotherapy.Afterward,total rectal mesentery resection was performed,and postoperatively,2 and 6 courses of CAPOX chemotherapy were continued.Follow-up was conducted until 31 December 2021,with the primary observation being the disease-free survival(DFS)of patients in both groups.Secondary observations included overall survival(OS)time,lesion progression-free survival(PFS)time,local recurrence rate,and the rate of acute toxicity events.Cox regression analyses were conducted to compare the factors influencing DFS.Results Among the 446 patients,303(67.9％)were male and 143(32.1％)were female.The patients in the observation group were found to be younger and had a higher proportion of Eastern Collaborative Oncology Group(ECOG)physical status score 0 compared to the control group(both P＜0.05).Additionally,the two groups differed significantly in terms of MRI T stage,N stage,distance from the external anal verge,rectal mesorectal fascial infiltration,pathological stage,and chemotherapy-to-surgery time interval(all P＜0.05).Throughout a mean follow-up period of(20.7±3.5)months,there were 76 deaths,89 distant metastases,and 32 local recurrences.The results of Kaplan-Meier survival analysis revealed that the observation group had a higher disease-free survival(DFS)rate at 2 years of follow-up compared to the control group[73.8％(79/107)vs.68.1％(231/339),Log-rank x2=2.676,P=0.041].Additionally,the median DFS time was longer in the observation group[19(12,22)months]compared to the control group[16(11,19)months](Z=2.774,P=0.038).Furthermore,the observation group exhibited a significantly longer OS time[26(21,33)months]compared to the control group[22(18,14)months](Z=2.879,P=0.032).However,the median PFS time was similar in both groups[20(14,25)months vs.16(12,21)months](Z=1.545,P=0.123).The incidence of distant metastasis was 18.7％(20/107)in the observation group and 20.4％(69/339)in the control group(Log-rank x2=0.341,P=0.708),indicating no significant difference.Similarly,there was no significant difference in the risk of local recurrence between the observation group[9.3％(10/107)]and the control group[6.5％(22/339)](Log-rank x2=0.996,P=0.318).In terms of adverse reactions,there was no statistically significant difference in the incidence of grade≥ 3 acute toxic reactions between the two groups[19.6％(21/107)vs.12.1％(41/339),Log-rank x2=1.661,P=0.148].A multifactorial Cox regression analysis revealed that age(HR=0.586,P=0.005),ECOG score(HR=0.721,P=0.028),MRI T-stage(HR=0.605,P=0.008),rectal mesenteric fascial infiltration(HR=1.649.P=0.012),and distance from the external anal verge(HR=0.638,P=0.041)were associated with DFS.Conclusions The findings indicate that the combination of preoperative short-course radiotherapy and neoadjuvant chemotherapy in elderly patients with locally advanced rectal cancer demonstrates favorable short-term effectiveness and safety.This approach shows promise in improving outcomes for elderly patients with locally advanced rectal cancer.
万方数据
维普
