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Capecitabine-based Neoadjuvant Chemoradiation Therapy in Locally-advanced Rectal Cancer
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ÃÖÈ«Á¶ ( Choi Hong-Jo )
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¹Ú±âÀç ( Park Ki-Jae )
µ¿¾Æ´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
ÀÌÇü½Ä ( Lee Hyung-Sik )
µ¿¾Æ´ëÇб³ ÀÇ°ú´ëÇÐ ¹æ»ç¼±Á¾¾çÇб³½Ç
ÀÌŹ« ( Lee Tae-Mu )
µ¿¾Æ´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
ÇÏ»ó½Ä ( Ha Sang-Sik )
µ¿¾Æ´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
ÀÌÈ£¿µ ( Lee Ho-Young )
µ¿¾Æ´ëÇб³ ÀÇ°ú´ëÇÐ ¿Ü°úÇб³½Ç
KMID : 0356720100260020137
Abstract
¸ñÀû: ÀÌ ¿¬±¸´Â ÀýÁ¦°¡´ÉÇÑ ÁøÇ༺ Á÷Àå¾Ï ȯÀÚ¿¡¼ ¼ö¼ú Àü Ä¡·á·Î¼ capecitabineÀ» º´¿ëÇÑ ÈÇйæ»ç¼±Ä¡·áÀÇ È¿´É°ú ¾ÈÀü¼ºÀ» Æò°¡ÇÏ°íÀÚ ½ÃÇàµÇ¾îÁ³´Ù.
¹æ¹ý: ÁøÇ༺ Á÷Àå¾Ï ȯÀÚ(cT3/4, N-/+) 35¸íÀ» ´ë»óÀ¸·Î ¼ö¼ú Àü ÈÇйæ»ç¼±Ä¡·á·Î¼ °æ±¸ capecitabine (¹æ»ç¼±Ä¡·á ±â°£ µ¿¾È ¸ÅÀÏ 825 mg/m2¸¦ ÇÏ·ç µÎ ¹ø) Åõ¿©¿Í ¹æ»ç¼±Ä¡·á(ÃÑ ¹æ»ç¼±·® 50.4 Gy¸¦ 28 ºÐȹ)¸¦ µ¿½Ã¿¡ ½ÃÇàÇÏ¿´À¸¸ç, ¼ö¼úÀº ÈÇйæ»ç¼±Ä¡·á ¿Ï·á 6-8ÁÖ ÈÄ¿¡ ½ÃÇàÇÏ¿´´Ù. ¼ö¼ú ÈÄ¿¡´Â º¸Á¶Àû Ç×¾ÏÈÇÐÄ¡·á·Î¼ 4-6ÁÖ±âÀÇ capecitabine (3ÁÖ °£°ÝÀ¸·Î 1,250 mg/m2¸¦ ÇÏ·ç µÎ ¹ø 2ÁÖ°£)À» Åõ¿©ÇÏ¿´´Ù.
°á°ú: µÎ ȯÀÚ¿¡¼ 3µµ ¼³»ç·Î 2ÁÖ°£ capecitabine Åõ¿©¿Í ¹æ»ç¼±Ä¡·á¸¦ Áß´ÜÇß´ø °æ¿ì¸¦ Á¦¿ÜÇÏ°í´Â ¸ðµç ȯÀÚ¿¡¼ °èȹµÈ ÈÇйæ»ç¼±Ä¡·á¸¦ ¿Ï·áÇÏ¿´´Ù. ¼ö¼úÀº ÀúÀ§Àü¹æÀýÁ¦¼ú ÈÄ È¯»óÀýÁ¦¿¬ ¾ç¼º(R1)À̾ú´ø 1¿¹ÀÇ È¯ÀÚ¸¦ Á¦¿ÜÇÏ°í´Â ¸ðµç ȯÀÚ¿¡¼ ÀüÁ÷Àå°£¸· ÀýÁ¦¼úÀÇ ¿øÄ¢ÇÏ¿¡ ÀÜÁ¸Á¾¾ç À½¼ºÀÇ ±ÙÄ¡ÀýÁ¦(R0)°¡ ½ÃÇàµÇ¾ú´Ù(ÀúÀ§Àü¹æÀýÁ¦¼ú, 26¿¹; °ý¾à±Ù°£ÀýÁ¦¼ú, 6¿¹; º¹È¸À½ÀýÁ¦¼ú, 2¿¹). ¿ø¹ßÁ¾¾ç°ú ¸²ÇÁÀýÀÇ º´±âÇÏ°(downstaging)Àº °¢°¢ 57%¿Í 60%¿¡¼ °üÂûµÇ¾úÀ¸¸ç, ¿ø¹ßÁ¾¾ç°ú ¸²ÇÁÀýÀ» Æ÷ÇÔÇÑ Àüü º´±âÇÏ°·üÀº 77%(27¿¹)¿´´Ù. ¿ø¹ßÁ¾¾çÀÇ º´¸®ÇÐÀû ¿ÏÀü°üÇØÀ²Àº 11%·Î¼ 4¿¹¿¡¼ °üÂûµÇ¾ú´Ù. ÈÇйæ»ç¼±Ä¡·á ±â°£ µ¿¾È 4µµ µ¶¼ºÀº °üÂûµÇÁö ¾Ê¾ÒÀ¸¸ç 3µµ µ¶¼ºµµ 2¿¹ (6%)ÀÇ ¼³»ç°¡ À¯ÀÏÇÏ¿´´Ù. ÃßÀû±â°£ 38°³¿ù µ¿¾È 4¿¹ÀÇ È¯ÀÚ¿¡¼ ¿ø°ÝÀüÀÌ°¡ °üÂûµÇ¾úÀ¸¸ç(´Ù¹ß¼º ÆóÀüÀÌ 2¿¹; ´ëµ¿Á¤¸Æ ¸²ÇÁÀý, 2¿¹), ´Ù¸¥ 2¿¹ÀÇ È¯ÀÚ¿¡¼ ±¹¼ÒÀç¹ßÀÌ È®ÀεǾî 3³â ¹«º´»ýÁ¸À²Àº 83%¿´´Ù.
°á·Ð: ÀýÁ¦°¡´ÉÇÑ ÁøÇ༺ Á÷Àå¾Ï ȯÀÚ¿¡¼ capecitabineÀ» º´¿ëÇÑ ¼ö¼ú Àü ÈÇйæ»ç¼±Ä¡·á´Â È¿°úÀûÀÌ¸ç ¾ÈÀüÇÑ Ä¡·á¾ç½ÄÀ¸·Î ÆǴܵȴÙ.
Purpose: The aim of the study was to evaluate the efficacy and the toxicity of preoperative treatment with capecitabine in combination with radiation therapy (RT) in patients with locally-advanced, resectable rectal cancer.
Methods: Thirty-five patients with locally-advanced rectal cancer (cT3/4, N-/+) were treated with capecitabine (825 mg/m2, twice daily for 7 days/wk) and concomitant RT (50.4 Gy/28 fractions). Surgery was performed 6-8 wk after completion of the chemoradiation followed by 4-6 cycles of adjuvant capecitabine monotherapy (1,250 mg/m2, twice daily for 14 days every 3 wk).
Results: The chemoradiation program was completed in all but 2 patients, for whom both capecitabine and RT were interrupted for 2 wk because of grade-3 diarrhea. A R0 resection under the principle of total mesorectal excision (low anterior resection, 26; intersphincteric resection, 6; abdominoperineal resection, 2) was performed in all but one patient with a low anterior resection with positive circumferential margin (R1). Primary tumor and node downstaging occurred in 57% and 60% of patients, respectively. The overall rate of downstaging, including both the primary tumor and node, was 77% (27 patients). A pathological complete response of the primary tumor was achieved in 4 patients (11%). No patient had grade-4 toxicity, and the only grade-3 toxicity developed was diarrhea in 2 patients (6%) during chemoradiation. During a median follow-up of 38 mo, distant metastases developed in 4 patients (multiple lung metastases, 2; aortocaval nodal metastases, 2), and another 2 patients showed local recurrence. The three-year disease-free survival was 83%.
Conclusion: This study suggests that preoperative capecitabine-based chemoradiation therapy is an effective and safe treatment modality for the tratment of locally-advanced, resectable rectal cancer.
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Á÷Àå¾Ï;¼ö¼úÀü ÈÇйæ»ç¼±Ä¡·á;Capecitabine
Rectal cancer;Neoadjuvant chemoradiation;Capecitabine
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