CAJ | 학술논문

目的探讨新辅助化放疗对进一步提高局部进展期低位直肠癌疗效的作用,并探讨临床完全缓解病例的处理方法.方法 2001年5月至2007年8月对192例局部进展期低位直肠癌患者予以放疗40至46 Gy,分次剂量为2 Gy/d,每周5 d休息2 d,共4周完成放疗.在放疗开始的同时予以卡培他滨1250 mg·m~(-2)·d~(-1),分2次口服,连续服用至手术.放疗结束后休息6周进行手术,手术均按全直肠系膜切除术(TME)操作规范进行.结果本组192例患者均完成预定的放化疗.117例(60.9%)出现不良反应,17例(8.9%)复查提示肿瘤完全消失未行手术而予以随访(随访组).175例患者施行根治性手术(手术组),其中低位前切除术(LAR)134例,结肠肛管吻合术(Parks术)32例(其中6例术中加作预防性横结肠造口),腹会阴切除术(APR)9例,总保肛率为94.9%.术后病理检查显示24例(12.5%)未见癌细胞及阳性淋巴结.手术组按病理分期为T0N0期24例,T2N0期43例,T2N1期11例,T3N0期77例,T3N1期13例,T4N0期5例,T4N1期2例,共有135例(77.1%)达到病理降期.全组无手术死亡,术后5例出现直肠阴道漏,4例吻合口漏,总吻合口漏发生率5.1%(9/175).192例患者均获随访,中位随访42个月(12～87个月).随访期间肺转移11例,肝转6例,局部复发7例,总复发率达12.5%,其中12例死亡,全组病死率6.3%.临床完全缓解病例(随访组)3年生存率为100%,病理完全缓解病例(手术组)3年生存率为100%.结论对于局部进展期低位直肠癌辅助化放疗可有效达到肿瘤降期的目的 ,提高根切率和保肛率,进一步降低局复发率.经严格筛选达到临床完全缓解的病例,可暂不手术,严密随访,是安全的.
목적 탐토신보조화방료대진일보제고국부진전기저위직장암료효적작용,병탐토림상완전완해병례적처리방법.방법 2001년5월지2007년8월대192례국부진전기저위직장암환자여이방료40지46 Gy,분차제량위2 Gy/d,매주5 d휴식2 d,공4주완성방료.재방료개시적동시여이잡배타빈1250 mg·m~(-2)·d~(-1),분2차구복,련속복용지수술.방료결속후휴식6주진행수술,수술균안전직장계막절제술(TME)조작규범진행.결과 본조192례환자균완성예정적방화료.117례(60.9%)출현불량반응,17례(8.9%)복사제시종류완전소실미행수술이여이수방(수방조).175례환자시행근치성수술(수술조),기중저위전절제술(LAR)134례,결장항관문합술(Parks술)32례(기중6례술중가작예방성횡결장조구),복회음절제술(APR)9례,총보항솔위94.9%.술후병리검사현시24례(12.5%)미견암세포급양성림파결.수술조안병리분기위T0N0기24례,T2N0기43례,T2N1기11례,T3N0기77례,T3N1기13례,T4N0기5례,T4N1기2례,공유135례(77.1%)체도병리강기.전조무수술사망,술후5례출현직장음도루,4례문합구루,총문합구루발생솔5.1%(9/175).192례환자균획수방,중위수방42개월(12～87개월).수방기간폐전이11례,간전6례,국부복발7례,총복발솔체12.5%,기중12례사망,전조병사솔6.3%.림상완전완해병례(수방조)3년생존솔위100%,병리완전완해병례(수술조)3년생존솔위100%.결론 대우국부진전기저위직장암보조화방료가유효체도종류강기적목적 ,제고근절솔화보항솔,진일보강저국복발솔.경엄격사선체도림상완전완해적병례,가잠불수술,엄밀수방,시안전적.
Objective To explore the possibility of further improvement of the efficacy of neoadjuvant chemoradiotherapy in locally advanced lower rectal cancer and the management of patients with clinical complete regression. Methods From May 2001 to August 2007, 192 cases with locally advanced lower rectal cancer (T3/T4 or N~+) received preoperative radiotherapy 40-46 Gy/20-23 fractions and concomitant oral capocitabine 625 mg/m~2 bid for 10 weeks prior to surgery. Curative resection with total mesorectal excision (TME) was carried out 6 weeks after the end of radiation. Results As a result, 117 cases (60.9%) experienced adverse events but only 2 suffered from G3 side effects. Seventeen cases (8.9%) had a clinical complete tumor regression without surgery; 175 patients underwent curative resection, of them 134 cases with low anterior resection (LAR), 32 cases with ultra-low anterior resection with Park's coloanal anastomosis (6 cases with diverting temporary colostomy) and 9 cases with abdominal pelvic resection (APR). Sphincter preservation was achieved in 94. 9%. Twenty-four patients (12.5%) got pathological complete response (CR), 17 patients with clinical CR and the overall CR rate was 21.4%. According to the pathological staging post operation: T0N0 41 cases, T2N0 43 cases, T3N0 77 cases, T4N0 5 cases, T2N1 11 cases, T3N1 13 cases, T4N1 2 cases; Graded under Dworak's tumor regression: TRG0 8 patients,TRG1 32 patients, TRG2 28 patients,TRG3 83 patients and TRG4 24 patients, with an overall pathological tumor downstsging in 77.14%. No operative death occurred, 5 patients suffered from rectovaginal fistulas and 4 anastomotic leakages with an overall anastomotic leakage rate of 5.1% (9/175) and all the patients recovered uneventfully after properly managed. All patients were followed up for a median time of 42 months (range, 12-87 months). During the time, 11 patients developed lung metastases, 6 liver metastases and 7 had local recurrences. The 3 years disease-free survival (DPS) was 86. 6% and overall survival (OS) was 92.6%. Conclusions Neoadjuvant chemoradiotherapy has high efficacy in locally advanced lower rectal cancer, resulting in tumor down-staging, improved resectability and sphincter preservation, and reduced local recurrences. Meanwhile the cases with clinical complete response can be followed up closely and safely without surgery.