국소진행성 직장암에서 수술 전 방사선 및 항암화학 동시요법의 효과

Abstract

Purpose :We conducted a prospective non-randomized clinical study to evaluate the efficacy and toxic of the preoperative concurrent chemoradiotherapy for locally advanced unresectable rectal cancer. Materials and Methods: Between January 1995 and June 1998, 37 conecutive patients with locally unresectable advanced rectal cancer were entered into the study. With 3- or 4- fields technique, a total of 45 Gy radiation was delivered on whole pelvis, followed by 5.4 Gy boost to the primary tumor in some cases. Chemotherapy was done at the first and fifth week of radiation with bolus i.v. 5-Fluorouracil (FU) 370~450 mg/m2, days 1~5, plus Leucovorin 20 mg/m2, days 1~5. OF 37 patients, 6 patients did not receive all planned treatment course (refusal in 4, disease progression in 1, metastasis to lung in 1). Surgical resection was undergone 4~6 weeks after preoperative concurrent chemoradiotherapy. Results :Complete resection rate with negative margins was 94% (29/31). Complete response was seen in 7 patients (23%) clinically and 2 patients (6%) pathologically. Down staging of tumor occured in 21 patients (68%). Treatment related toxicity was minimal except grade III & IV leukopenia in 2 patients, respectively. Conclusion : Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer was effective in inducing down staging and complete resection rate. Treatment related toxicity was minimal. Further follow up is on-going to determine long term survival following this treatment.