A retrospective outcome study in the elder patient with locally advanced rectal cancer treated with hypofractionated or conventional preoperative radiotherapy
Notice bibliographique
Résumé
Background: Neoadjuvant chemoradiotherapy is considered the standard approach for T3-4 M0 rectal cancer; however, the optimal dose remains undefined for the elderly. We performed a retrospective analysis to compare conventional (C) and hypofractionated (HF) schedules in elderly patients. We compared survival rates, local control and morbidity. Methods: From 2000 to 2008, 177 patients older than 65 years with T3-4 M0 rectal cancer received preoperative radiotherapy according to either a conventional protocol (45 to 50.4 Gy in 1.8-2 Gy daily fractions) or a hypofractionated (39 Gy in 3 Gy daily fractions) protocol. Fifty-five patients in the conventional group and none of the patients in the hypofractionated group received concomitant chemotherapy. Both groups were equivalent in terms of their characteristics. The median follow-up was 36 months. Results: The occurrence of early grade 3-4 radiation toxicity was equivalent between the 2 groups (7%). Surgery was performed in 98% of the patients in the HF group versus 92% in the conventional ( p =0.08). The delay between radiotherapy and surgery was 22 days in the HF group versus 45 days in the conventional group ( p =0.0021). The downstaging rates were 39% in HF group and 45% in the C group ( p =0.53). For lower rectum tumors, the conservative surgery rates were 43% in the HF group and 35% in the C group, ( p =0.52). The postoperative death rates at 30 days were equal between the two groups (3%). The 5-year local control rates was 87.3% in group C and 91.7% in group HF ( p =0.5). Based on a Kaplan-Meier analysis, the 1-, 3- and 5-year overall survival rates were 88%, 67% and 45%, respectively, in the C group and 84%, 60% and 39%, respectively, in the HF group ( p =0.28). In a multivariate analysis, the prognostic factors for overall survival were a Charlson index < 2 ( p =0.0034 HR=0.3), pT stage ≤2 ( p =0.0042 HR=0.16), pN0 stage ( p =0.0072 HR=0.388), and downstaging ( p =0.0498 HR=0.651). Radiation schedule and concomitant chemotherapy had no impact. Conclusion: In this series, the local control rates and the overall survival results are equivalent for patients treated with HP and C radiation schedules. As hypofractionated radiotherapy is more convenient for elderly patients and has equivalent morbidity, additional prospective studies with this population could be of great interest.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».