국소 진행된 직장암의 수술 전 화학방사선 요법 치료 후 종양반응 분석: 종양체적 변화와 병리조직학적 병기하강과의 상관관계 분석
Analysis of Criteria for Tumor Response after Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Correlation between Tumor Volume Reduction andHistopathologic Downstaging
김남규, 표홍렬, 백승혁, 이강영, 손승국, 조장환, 라선영, 정현철,
소속 상세정보
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
표홍렬 ( Pyo Hong-Ryull )
국립암센터 양성자치료센터
백승혁 ( Paik Seung-Hyuk )
연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
조장환 ( Cho Jang-Hwan )
연세대학교 의과대학 외과학교실
라선영 ( Rha Sun-Young )
연세대학교 의과대학 종양내과학교실
정현철 ( Jung Hyun-Chul )
연세대학교 의과대학 종양내과학교실
KMID : 0356720040200050296
Abstract
Purpose: Preoperative chemoradiation treatment (CCRT) for locally advanced rectal cancer has been known to be safe and effective. The aim of study is to find any correlation between tumor volume reduction and histopathologic downstaging in locally advanced rectal cancer by preoperative CCRT.
Methods: A total of 16 patients of rectal cancer were selected. They had been T3,4 N (+) preoperatively staged by using a transrectal ultrasonography and pelvic MRI. Radiation was given, a total of 5,040 cGy over 5 weeks, and systemic chemotherapy was also given 5 FU 450 mg/m2 and leucovorin 20 mg/m2 concurrently intravenously during the first and the fifth week of CCRT. Surgery was done 4∼6 weeks after completion of CCRT.
A 3D CT image was obtained with AcQsim PQ 5000 3D (Philips, USA). Tumor volume was measured before and after CCRT.
Results: The type of operative procedures were abdominoperineal resection 7, low anterior resection 5, coloanal anastomosis 3 and Hartmann operation 1. Volume reduction was ranged from 14.6% to 84.4%. Over a 50% tumor volume reductions were in 9 patients (56.2%). Pathologic complete remission was observed in 2 patients (12.5%), who showed 72% and 58.5% tumor volume reductions. Patients showing pT and/or pN downstaging patients (N=9) had a 55.9% tumor reductions (14.6∼84.4%), and patients showing no pT and/or pN downstaging (N=7) had 51.8% volume reduction (24.7∼79%).
Conclusions: Preoeperative CCRT has been thought to be able to decrease tumor size and volume and to increase respectability. However, among our 9 patients
who showed over 50% tumor volume reductions, 3 patients did not show any T and N downstaging, which is really important for long-term oncologic outcomes. J Korean Soc Coloproctol 2004;20:296-302
키워드
수술 전 화학방사선 요법;직장암;종양용적 변화;병기 하강
Preoperative chemoradiation;Rectal cancer;Tumor volume reduction;Pathologic downstaging
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