Second primary malignancy risk after radiotherapy in rectal cancer survivors

AIM To investigate second primary malignancy(SPM) risk after radiotherapy in rectal cancer survivors METHODS We used Taiwan's National Health Insurance Research Database to identify rectal cancer patients between 1996 and 2011. Surgery-alone, preoperative short course, preoperative long course, and post-operative radiotherapy groups were defined. The overall and sitespecific SPM incidence rates were compared among the radiotherapy groups by multivariate Cox regression, taking chemotherapy and comorbidities into account. Sensitivity tests were performed for attained-year adjustment and long-term survivors analysis. RESULTS A total of 28220 patients were analyzed. The 10-year cumulative SPM incidence was 7.8% [95% confidence interval(CI): 7.2%-8.2%] using a competing risk model. The most common sites of SPM were the lung, liver, and prostate. Radiotherapy was not associated with increased SPM risk in multi-variate Cox model(hazard ratio = 1.05, 95%CI: 0.91-1.21, P = 0.494). The SPM hazard remained unchanged in 10-yearsurvivors. In addition, no SPM risk difference was found between the preoperative radiotherapy and postoperative radiotherapy groups.CONCLUSION In this large population-based cohort study, we demonstrated that radiotherapy had no increase in SPM.

直肠癌术前同步放化疗不同放疗分割方式的临床研究

目的评价直肠癌术前改良短程放化疗与常规分割放化疗疗效和安全性。方法60例可切除直肠癌患者随机分成术前改良短程放化疗（A组，30例，30Gy分10次）和常规分割放化疗（B组，30例，45Gy分25次），分别在放化疗后2周和6～8周手术。结果A组和B组病理降期率分别为30％和67％（P=0．004）、保肛率分别为53％和68％（P=0．291）、R0切除率分别为97％和100％（P=0．236）、3年0s率分别为83％和88％（P=0．717）、3年局部复发率分别为10％和7％（P=0．639）、3年远地转移率分别为27％和30％（P=0．774）。两组中有降期及无降期患者3年OS率分别为97％及74％（P=0．016）；A组1-3级放射性皮炎、2级放射性肠炎、2级白细胞减少发生率、吻合口瘘及伤口延期愈合率与B组相近（P=0．092～0．717）。结论术前改良短程放化疗及常规分割放化疗均可作为可切除直肠癌术前新辅助放化疗选择方案，且术前改良短程放化疗有治疗周期短、住院时间短、费用低、患者易接受等优势。