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국소 진행성 직장암에서 수술 전 항암 화학약물 및 방사선 병행치료의 효과

The Effect of Preoperative Concurrent Chemoradiation in Locally Advanced Rectal Cancer

대한대장항문학회지 2005년 21권 2호 p.89 ~ 99
조현민 ( Cho Hyeon-Min ) - 가톨릭대학교 의과대학 성빈센트병원 외과학교실

김준기 ( Kim Joon-Gi ) - 가톨릭대학교 의과대학 성빈센트병원 일반외과
정헌 ( Jung Hun ) - 가톨릭대학교 의과대학 외과학교실
허윤정 ( Heo Yoon-Jung ) - 가톨릭대학교 의과대학 외과학교실
원용성 ( Won Yong-Sung ) - 가톨릭대학교 의과대학 성빈센트병원 외과학교실
전경화 ( Jun Kyong-Hwa ) - 가톨릭대학교 의과대학 외과학교실
진형민 ( Chin Hyung-Min ) - 가톨릭대학교 의과대학 외과학교실
박우배 ( Park Woo-Bae ) - 가톨릭대학교 의과대학 외과학교실
전정수 ( Chun Chung-Soo ) - 가톨릭대학교 의과대학 외과학교실

Abstract


Purpose: Tumor downstaging from preoperative chemoradiation has been associated with an increased probability of a sphincter-saving procedure and with improved local control and survival rate. We observed the effect and the prognostic value of pathologic tumor downstaging, including complete pathologic response to preoperative concurrent chemoradiation, resectability, sphincter-saving rate, disease- free survival, and overall survival in locally advanced rectal cancer patients.

Methods: From January 2000 to December 2003, we recruited a total 78 patients with computed tomography stages II and III rectal cancer which was treated by using preoperative concurrent chemoradiation; all patients had a radical resection with total mesorectal excision. Surgical resection was performed 6 to 8 weeks after completing the radiation therapy. The average follow up was 25.40±13.64 months.

Results: The number of patients according to CT stage before preoperative chemoradiation was 39 (II) and 39 (III). Tumor downstaging occurred in 51 (65.4%) patients, including 11 (14.1%) patients who had a complete pathologic response. Tumor size, radiation dose, and clinical stage were associated with tumor downstaging in the univariate analysis. None of the clinical or pathologic variables was associated with a complete pathologic response. The overall resectability was 100%. The number of sphincter-saving procedures were 61 (78.2%). Recurrence occurred in 17 (21.8%) patients: local recurrence in 4 (5.1%) and distant metastasis in 13 (16.7%). None of the patients with a complete pathologic response recurred. Recurrences were 3 (17.6%)/7 (22.6%)/7 (36.8%) for pathologic stages I/II/III. Recurrence was more common among younger patients (P<0.05). Patients in the complete pathologic response group had more favorable disease-free survival compared with other group (yp stage I, II, III) (P=0.026).

Conclusion: Preoperative concurrent chemoradiation for locally advanced rectal cancer seems to afford some potential advantages: high tumor response, resectability, and feasible sphincter preservation, and even a complete pathologic response. A complete pathologic response to preoperative chemoradiation is associated with an improved disease-free survival.

키워드

직장암;국소 진행성;수술 전 항암 약물 방사선 요법;병기감소
Rectal cancer;Locally advanced;Preoperative concurrent chemoradiation;Downstaging
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