절제가능한 직장암의 수술전 방사선치료

Abstract

Purpose : This is a Phase Ⅰ/Ⅱ study of preoperative concurrent radiation and chemotherapy in tethered and fixed rectal carcinoma. This study examined the tumor response, the curative resectability, the toxicities related with chemoradiotherapy. Methods and Materials : Between 1995 and 1998, 37 patients with tethered and fixed rectal carcinoma were entered into the study. Patients were treated with pelvic radiotherapy (45 Gy in 25 fraction) and concurrent chemotherapy (5-FU 350-450㎎ /m2 Ⅳ bolus x 5 days, Leucovorin 30 ㎎ Ⅳ x 5 days) on the first and the fourth week of radiotherapy. This was followed by surgery 4 to 6 weeks later. Results : Six patients did not finish the chemoradiotherapy due to patient's lack of cooperation in 3, progressive disease requiring emergency surgery in 1, who later was treated with palliative radiotherapy alone, and occurrence of lung metastasis in 1, who subsequently was treated with chemotherapy alone. Thirty-one of 37 patients completed the whole course of chemoradiotherapy and surgical resection. Curative resection with negative margin was done in 29 of 31 patients (94%). Clinical complete response and pathological complete response were seen in 7 (23%) and 2 (6%) patients, respectively. Down-staging was seen in 22 (71%). For treatment related toxicity, grade Ⅲ and Ⅳ leukopenia were seen in 3 and 2 patients, respectively. Conclusion : Preoperative concurrent chemoradiotherapy could achieve down-staging and a curative resection rate of 94% in locally advanced rectal cancer. Toxicity was minimal. Further study will be continued to investigate the efficacy of this treatment in terms of survival.