국소 진행된 직장암의 수술 전 항암 화학약물 및 방사선 병행 치료 효과
Preoperative Concurrent Chemoradiotherapy in Locally Advanced Rectal Cancer
김남규, 손승국, 민진식, 성진실, 노재경,
소속 상세정보
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
민진식 ( Min Jin-Sik )
연세대학교 의과대학 외과학교실
성진실 ( Seong Jin-Sil )
연세대학교 의과대학 방사선종양학교실
노재경 ( Noh Jae-Kyung )
연세대학교 의과대학 종양내과학교실
KMID : 0356720000160020093
Abstract
Purpose: Preoperative concurrent chemoradiation for locally advanced rectal cancer can reduce tumor volume and can eliminate viable tumor cells at surgical margin (lateral or posterior margin). It also achieve a rate of high resectability, and negative margin and also have been known to be a safe treatment modality even though its fatal complication was reported as 4%. The aim of this study is to analyze its efficacy and complications after concurrent chemoradiation treatment for advanced rectal cancer.
Methods: We recruited a total thirty three patients with locally advanced rectal cancer, which were staged preoperatively as T3 or T4 and multiple enlarged lymph nodes by Transrectal Ultrasonography or pelvic Magnetic Resonance Image between march 1996 and June, 1998. 5 Fluorouracil 450 ㎎/㎡ and leucovorin 30 ㎎ infused intravenously during the first and fifth weeks of radiation therapy (4500∼5040 cGy). Surgical resection was performed after four or six weeks after completing radiation therapy. To follow up tumor response, digital rectal examination and transrectal ultrasonography were done every two weeks.
Results: Tumor level was distal (N=16, 48.4%), middle (N=9, 27.2%) and upper (N=8, 24.4%). mean age was fifty two years old. Overall resectability was 91%. Types of operations were abdominoperineal resection (N=10, 30.3%), Low anterior resection (N=8, 24.2), Hartmann (N=8, 24.2%), Posterior exenteration (N=2. 6.1%), Total pelvic exenteration (N=2, 6.1%), colostomy only (N=3, 9.1%). Tumor response was Complete remission (N=3,10%), Partial response (N=17, 57%), Non-response (N=10, 33%), progressive disease (N=3). Pathological status was No residual tumor (N=3, 10%), T2N1 (N=5, 16.6%), T3N0 (N=6, 20%), T4N0 (N=4, 13.3%), T2N1 (N=1, 3.3%), T3N1 (N=11, 36.6%). Downstaging status was as follows: from T3 to T0 (N=2), to T2 (N=3) and From T4 to T0 (N=1), to T2 (N=3), to T3 (N=3). Postoperative morbidity was noted in 2 patients (1 case of anastomotic leakage, 1 case of wound infection).
Conclusion: Preoperative concurrent chemoradiation therapy for locally advanced rectal cancer can be performed safely and show high tumor response and resectability.
키워드
Rectal cancer;Preoperative;Chemoradiotherapy
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