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국소 진행성 직장암의 수술 전 화학방사선치료의 성적

Preoperative Chemoradiation Therapy in the Management of Locally Advanced Rectal Cancer

대한대장항문학회지 2005년 21권 1호 p.19 ~ 26
김익용 ( Kim Ik-Yong ) - 연세대학교 원주의과대학 외과학교실

신대근 ( Shin Dae-Geun ) - 연세대학교 원주의과대학 외과학교실
박경란 ( Park Kyung-Ran ) - 연세대학교 원주의과대학 방사선종양학교실
성승훈 ( Seong Seung-Hoon ) - 연세대학교 원주의과대학 외과학교실
주영근 ( Chu Young-Keun ) - 연세대학교 원주의과대학 외과학교실
김대성 ( Kim Dae-Sung ) - 연세대학교 원주의과대학 외과학교실

Abstract


Purpose: Surgery is the standard care in the treatment of rectal cancer. However, after surgery alone, local recurrence and distant metastasis remain high for locally advanced rectal cancer. Preoperative chemoradiation therapy (pre-CRT) has been thought to be effective for increasing resectability and decreasing the rate of local recurrence for locally advanced rectal cancer. This study was designed to assess the efficacy of preoperative concurrent chemoradiation therapy in the management of locally advanced rectal cancer.

Methods: Between July 1999 and December 2003, 29 patients had locally advanced rectal cancer (uT3/ T4, uN1 by endorectal ultrasonography) or were ineligible to undergo sphincter-preserving surgery. All patients were treated with pre-CRT, followed by surgery in 25 patients. Patients were treated with radiation therapy with a total dose of 45~50.4 Gy to the surgical bed and pelvic lymph- node area for 5.5 weeks. We analyzed the degree of toxicity and the therapeutic resopnse from CRT, the type of surgery, including sphincter-saving procedures, and the mid- term outcome.

Results: Of the 29 patients who received pre-CRT, a radical resection was possible in 25 patients. A low anterior resection and an ultra-low anterior resection- coloanal anastomosis were performed in 13 (52%) and 7 (28%) cases, respectively. Sphincter-preserving surgery was performed in 80% of the patients. The postoperative pathological response rates of CRT were 25% complete remission, 45% partial remission, 30% no response. Postoperative complications and toxicity from CRT were
acceptable. The duration of median follow-up was 24 months (9~62 months). Recurrence was seen in 6 cases. Distant recurrence alone was seen in 5 patients (19.2%) and distant and local recurrences were seen in only one patient (4%). The 3-year overall survival rate was 72.4%, and 3-year disease-free survival rate was 59.5%.

Conclusion: Our data suggested that preoperative concurrent CRT therapy for locally advanced rectal cancer is safe and tolerable. These data showed a high local control rate and a high 3-year survival rate. Preoperative CRT was an effective modality for sphincter preservation in selected patients who would have required an abdominoperineal resection. Additional studies with larger numbers of patients and long-term follow up are warranted to confirm our results. In addition, more effective chemotherapeutic regimens are needed to decrease distant metastasis.

키워드

직장암;수술 전 화학방사선 보조치료;근치적 절제술;재발;생존율
Rectal cancer;Preoperative chemoradiotherapy;Radical resection;Recurrence;Survival
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