국소 진행성 직장암에서 수술전 방사선-화학요법
The Outcome of Preoperative Chemoradiation to Locally Advanced Rectal Cancer
박형석, 안병권, 이승현, 백승언,
소속 상세정보
박형석 ( Park Hyung-Seok )
고신대학교 의과대학 외과학교실
안병권 ( Ahn Byung-Kwon )
고신대학교 의과대학 외과학교실
이승현 ( Lee Seung-Hyun )
고신대학교 의과대학 외과학교실
백승언 ( Baek Sung-Uhn )
고신대학교 의과대학 외과학교실
KMID : 0356720040200050277
Abstract
Purpose: Tumor downstaging after preoperative chemoradiation has been associated with an intent to improve anal sphincter preservation, resectability, local control, and possibly survival in locally advanced rectal cancer. We performed this study to evaluate the outcome of preoperative chemoradiation for locally advanced rectal cancer.
Methods: We retrospectively reviewed the cases of 82 patients who had been treated by using preoperative chemoradiation combined with surgery for adenocarcinoma of the rectum between January, 1995, and December, 2002. All patients had fixed or locally advanced lesions, which had been detected by using digital rectal examination. No distant
metastasis was proven before preoperative chemoradiation. All of the patients received the full scheduled dose of radiation (range, 3,000∼5,400 cGy). Concurrent intravenous
chemotherapy with 5-fluorouracil (450 mg/m2/day) and leucovorin (45 mg/day) was administered continuously on days 1∼5 and 29∼33. The mean interval between
chemoradiation and surgery was 5.6 weeks (2.7∼9.6 weeks). The survival rate was estimated by using the Kaplan-Meier method and the log-rank test. We compared
the survival of locally advanced rectal cancers treated by using preoperative chemoradiation with surgery with that of 444 patients with resectable rectal cancers treated by using curative surgery alone during same period.
Results: A curative resection could be performed on 64 of the 82 patients (78.2%). A sphincter-preserving surgery was performed on 42 patients (51.2%). A pathologic complete response (pCR) occurred in 6 patients (7.3%). The 5-year
survival rates of patients with a pCR was 66.7%. In the comparison of the 5-year survival rates between patients with locally advanced rectal cancer treated by using preoperative
chemoradiation with curative surgery and patients with rectal cancer treated by using curative surgery alone, those of stage I, stage II, and stage III cancers were 100%
vs. 89.5%, 86.9% vs. 86.3%, and 52.9% vs. 63.3%, respectively (P＞0.05).
Conclusions: The survival rates for patients with locally advanced rectal cancers, which are expected to be unresectable or non-curative, treated by using preoperative chemoradiation with surgery were similar to those for patients with resectable rectal cancers treated by using curative surgery alone. We think that
preoperative chemoradiation with surgery improves the survival of patients with locally advanced rectal cancer. J Korean Soc Coloproctol 2004;20:277-282
키워드
술 전 방사선 화학요법;직장암;생존율
Preoperative chemoradiation;Rectal cancer;Survival rate
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