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절제 불가능한 결장직장암의 원격전이 환자에서 표적치료제를 포함한 선행항암화학요법 후 시행한 근치적인 절제술

Curative Resection Following Neoadjuvant Chemotherapy Including a Molecularly Targeted Agent in Patients with Unresectable Colorectal Distant Metastases

대한대장항문학회지 2008년 24권 3호 p.184 ~ 191
김진수 ( Kim Jin-Soo ) - 연세대학교 의과대학 외과학교실

민병소 ( Min Byung-Soh ) - 연세대학교 의과대학 외과학교실
허혁 ( Hur Hyuk ) - 연세대학교 의과대학 외과학교실
김남규 ( Kim Nam-Kyu ) - 연세대학교 의과대학 외과학교실
최진섭 ( Choi Jin-Sub ) - 연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook ) - 연세대학교 의과대학 외과학교실
조장환 ( Cho Jang-Hwan ) - 연세대학교 의과대학 외과학교실
안중배 ( Ahn Joong-Bae ) - 연세대학교 의과대학 내과학교실
노재경 ( Roh Jae-Kyung ) - 연세대학교 의과대학 내과학교실

Abstract


Purpose: A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases.

Methods: Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007.

Results: One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%).

Conclusions: Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted. J Korean Soc Coloproctol 2008;24:184-191

키워드

결장직장암;간 전이;표적치료제;근치적 절제술
Colorectal cancer;Liver metastasis;Molecularly targeted agent;Curative resection
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