국소 진행성 직장암에서 수술 전 항암 화학약물 및 방사선 병행 치료의 효과 및 수술 후 이환율에 미치는 영향
The Effects and Surgical Morbidity of Preoperative Combined Chemoradiotherapy for Locally Advanced Rectal Cancer
정지은, 김갑태, 정을삼,
소속 상세정보
정지은 ( Jung Ji-Eun )
전주예수병원 외과
김갑태 ( Kim Kab-Tae )
전주예수병원 외과
정을삼 ( Chung Eul-Sam )
전주예수병원 외과
KMID : 0356720010170060324
Abstract
Purpose: The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer.
Methods: Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 ㎎/㎡, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 ㎎/㎡, Days 1∼5, 29∼33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4∼8 weeks after completion of the chemoradiotherapy.
Results: Grade 3∼4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy.
Conclusions: Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.
키워드
직장암;국소 진행성;수술 전 화학 방사선 요법
Rectal cancer;Locally advanced;Preoperative chemoradiotherapy
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