진행성 직장암에서 술전 화학방사선 병행치료의 임상성적: 종양반응, 독성 및 합병증분석
Clinical Results of Postoperative Chemoradiation on Advanced Rectal Cancers: Tumor Response, Toxicities, and Morbidity
이동률, 이한일, 김호각, 김은영, 류현모, 윤상모, 김진천,
소속 상세정보
이동률 ( Lee Dong-Ryul )
대구가톨릭대학교 의과대학 외과학교실
이한일 ( Lee Han-Il )
대구가톨릭대학교 의과대학 외과학교실
김호각 ( Kim Ho-Gak )
대구가톨릭대학교 의과대학 내과학교실
김은영 ( Kim Eun-Young )
대구가톨릭대학교 의과대학 내과학교실
류현모 ( Ryu Hyun-Mo )
대구가톨릭대학교 의과대학 내과학교실
윤상모 ( Yoon Sang-Mo )
대구가톨릭대학교 의과대학 방사선종양학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 외과학교실
KMID : 0356720040200030138
Abstract
Purpose: Adjuvant chemotherapy and radiotherapy have been considered effective treatments in advanced rectal cancers. Recently, several studies have reported that preoperative chemoradiation (CRT) may have advantages over postoperative CRT, particularly in reducing local recurrence and preserving the anal sphincter. We studied the short-term efficacy of preoperative CRT for locally advanced rectal cancers.
Methods: Between Jun. 2000 and Aug. 2003, 23 patients were treated with preoperative CRT, followed by surgery (pre-CRT) and 31 patients were treated with chemoradiation postoperatively (post-CRT). We compared these two groups for the incidence and degree of side effects from CRT, postoperative complications, type of surgery, including anal sphincter preservation, and short-term recurrence.
Results: The average age and male-to-female ratio of the pre- and the post-CRT groups were 58±11, years and 13：10, and 61±14 and 14：17, respectively. T downstagings were observed in 17 of 23 (74%) pre-CRT patients. On the RTOG-EORTC scale, the patients who showed hematological, intestinal and dermal side effects in the pre-CRT group and in the post-CRT group were 5, 5, 2 and 5, 2, 4, respectively and the difference was not statistically significant (P=0.41). Anal sphincter preserving surgical procedures were performed 91.3% (21/23) and 83.9% (26/31) of the patients in the pre- and the post-CRT groups, respectively. But this difference was not statistically significant (P=0.4). Postoperative complications in the pre-CRT group were anastomosis site leakages (n=3) and rectovaginal fistula (n=1). In the post-CRT group, complications were two anastomosis site leakages. Four of the 31 post-CRT group patients had recurrences such as locoregional area (n=2), liver (n=1), and lung (n=1) while no patient was observed in pre- CRT group.
Conclusions: Although pre-CRT group showed higher incidence of complications than post-CRT group, these were managed easily and safely. Pre-CRT seems to be an effective modality for treating advanced rectal cancers particularly for preserving anal sphincter. Long-term follow- up data are needed to clarify the effect of pre-CRT. J Korean Soc Coloproctol 2004;20:138-144
키워드
직장암;방사선요법;수술 전 화학방사선요법
Rectal neoplasm;Radiotherapy;Preoperative chemoradiation
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