CAJ | 학술논문

目的评价术前同期放化疗用于局部进展期中低位直肠癌的有效性和耐受性.方法 2007-2013年共入组51例T3、T4期或N(+)的病理证实初治直肠癌患者.全盆腔三维放疗技术,45.0～50.4 Gy分25～ 28次;化疗采用FOLFOX4或XELOX方案,化疗在放疗开始第1、4周进行共2个周期;放化疗结束后4～8周手术,术后1个月内开始行同方案巩固化疗.Kaplan-Meier法计算生存率并Logrank检验和单因素分析及Cox模型行多因素预后分析.结果 49例患者完成术前放化疗及手术治疗,中位随访时间2.9年,总保肛率为65％,总降期率为59％.pCR为20％.总≥3级不良反应发生率为25％,总并发症发生率为31％.3、5年样本数分别为24、12例,3、5年OS分别为81％、69％,DFS分别为76％、60％,LRFS分别为78％、70％,DMFS分别为82％、74％.多因素分析显示肿瘤降期为5年DFS、LRFS的独立预后因素.结论局部进展期中低位直肠癌术前放疗同期FOLFOX4或XELOX方案化疗能提高病理降期率和pCR率及保肛率,降期者可能有更好的生存优势.
목적 평개술전동기방화료용우국부진전기중저위직장암적유효성화내수성.방법 2007-2013년공입조51례T3、T4기혹N(+)적병리증실초치직장암환자.전분강삼유방료기술,45.0～50.4 Gy분25～ 28차;화료채용FOLFOX4혹XELOX방안,화료재방료개시제1、4주진행공2개주기;방화료결속후4～8주수술,술후1개월내개시행동방안공고화료.Kaplan-Meier법계산생존솔병Logrank검험화단인소분석급Cox모형행다인소예후분석.결과 49례환자완성술전방화료급수술치료,중위수방시간2.9년,총보항솔위65％,총강기솔위59％.pCR위20％.총≥3급불량반응발생솔위25％,총병발증발생솔위31％.3、5년양본수분별위24、12례,3、5년OS분별위81％、69％,DFS분별위76％、60％,LRFS분별위78％、70％,DMFS분별위82％、74％.다인소분석현시종류강기위5년DFS、LRFS적독립예후인소.결론 국부진전기중저위직장암술전방료동기FOLFOX4혹XELOX방안화료능제고병리강기솔화pCR솔급보항솔,강기자가능유경호적생존우세.
Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer.Methods From June 2007 to June 2013,51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+))were included in this study.Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0-50.4 Gy/25-28 fractions.Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy.Surgery was performed at 4-8 weeks after chemoradiotherapy.Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis.Results Fortynine patients completed the preoperative chemoradiotherapy and surgery.The median follow-up was 2.9 years.The overall sphincter preservation rate was 65％;the overall downstaging rate was 59％.Ten (20.4％) of all patients achieved a pathologic complete response (pCR).Grade ≥3 toxicities occurred in 25％ of all patients,and the overall postoperative complication rate was 31％.The 3-and 5-year sample sizes were 24,12,respectively.The 3-and 5-year overall survival rates were 81％ and 69％,respectively;the 3-and 5-year disease-free survival (DFS) rates were 76％ and 60％,respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78％ and 70％,respectively;the distant metastasis-free survival rates were 82％ and 74％,respectively.The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS.Conclusions For locally advanced middle-low rectal cancer,preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate,pCR rate,and sphincter preservation rate.Patients with tumor downstaging may have a better survival advantage.