Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Preoperative Concurrent Radio-chemotherapy for Rectal Cancer: Report of Early Results

직장암에 대한 수술 전 동시병용 방사선-항암 화학요법: 초기 치료결과 보고

  • Shin, Seong-Soo (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Yong-Chan (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chun, Ho-Kyung (Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Woo-Yong (Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Won-Ki (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Young-Suk (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Joon-Oh (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Sang-Yong (Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim-Do-Hoon (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung, Eun (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Min-Kyu (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Yung-Je (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 신성수 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 안용찬 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 전호경 (성균관대학교 의과대학 삼성서울병원 일반외과) ;
  • 이우용 (성균관대학교 의과대학 삼성서울병원 일반외과) ;
  • 강원기 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 박영석 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 박준오 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 송상용 (성균관대학교 의과대학 삼성서울병원 병리과) ;
  • 임도훈 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 박원 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 이정은 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 강민규 (성균관대학교 의과대학 삼성서울병원 치료방사선과) ;
  • 박영제 (성균관대학교 의과대학 삼성서울병원 치료방사선과)
  • Published : 2003.06.01
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Abstract

Purpose: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer. Materials and Methods: From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery received preoperative CRCT. Thirty-seven patients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4$\~$6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients. Results: The compliance to the current preoperative CRCT protocol was excellent, where 92.5$\%$ (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9$\%$), while resection was abandoned during laparotomy in two patients (5.7$\%$). Gross complete resection was peformed in 30 patients, gross incomplete resection was peformed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5$\%$ (15/33), and the complete resection rate with the negative resection margin 78.8$\%$ (26/33). During the CRCT course, grade 3 $\~$4 neutropenia developed in four patients (10.8$\%$). Local recurrence after surgical resection developed in 12.1$\%$ (4/33), and distant metastases after the preoperative CRCT start developed in 21.6$\%$ (8/37). The overall 3-years survival rate was 87$\%$. Conclusion: Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.

목적: 수술 전 동시병용 방사선-항암 화학 요법의 초기 치료성적과 급성 부작용에 대해 알아보고자 하였다. 대상 및 방법: 1999년 6월부터 2002년 4월까지 T3또는 T4 병기의 직장암으로 진단 받고 완전절제가 어렵거나, 종양이 하부직장에 위치하여 수술 시 항문 괄약근의 보존이 불가능하리라고 예견된 40명의 환자에게 수술 전 동시병용 방사선-항암 화학요법을 적용하여 37명의 환자가 수술 전 치료방침을 완료하였다. 방사선치료는 전 골반부에 일일 1.8 Gy씩 5주간에 45 Gy를 엎드린 자세로 조사하였다. 항암 화학요법은 경구 UFT와 Leucovorin (LV)(12명), 정주 5-fluorouracil (FU)와 LV (10명), 정주 5-FU 단독요법(일시 정주 10명, 지속 정주 5명)을 각각 시행하였다. 수술은 수술 전 치료 종료 후 4$\~$6주경에 예정하였으며 35명에 대해서 수술을 시도하였다. 결과: 본 연구의 수술 전 방사선-항암 화학요법에 대한 순응도는 매우 높았. (92.5$\%$, 37/40). 수술 전에 간과 폐에 새로운 원격전이가 확인된 2명을 제외한 35명의 환자에서 절제수술을 시도하였고, 22명(62.9$\%$)에서 항문 괄약근의 보존이 가능하였으나, 2명(5.7$\%$)은 개복 후 절제수술을 포기하였다. 절제수술을 시행한 33명 중 30명은 육안적 완전절제를, 1명은 육안적 불완전절제를 시행하였으며 2명은 병리소견에 관한 정보를 얻을 수 없었다. 수술 및 병리소견에 근거한 병기하강률은 45.5$\%$ (15/33), 절제연 음성 완전절제율은 78.8$\%$ (26/33)였다. 수술 전 방사선치료 도중 급성 부작용으로 Grade 3$\~$4 호중구 감소가 4명(10.8$\%$)에서 발생하였다. 절제수술 후 국소 재발이 12.1$\%$ (4/33), 수술 전 치료방침 완료 후 원격 전이는 21.6$\%$ (8/37)에서 각각 나타났으며, 3년 생존율은 87$\%$였다. 결론: 직장암에 대한 수술 전 동시병용 방사선-항암 화학요법은 낮은 부작용으로 높은 수술절제율, 병기하강률, 완전절제율, 항문 괄약근 보존율 등을 얻을 수 있는 효과적인 방법으로 판단되며 앞으로 장기간에 걸친 추적관찰을 요한다.

Keywords

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