직장암에 대한 수술 전 방사선-화학요법 적용시 통상적인 영상진단 검사로 충분한가?

안병권 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.1

Background : Recently, preoperative chemoradiation has been accepted to control locally advanced rectal cancer according to increasing the anal sphincter preservation, improving the resectability and survival. However, patient selection of preoperative chemoradiation should be done carefully, because distant metastasis or peritoneal seeding of cancer was found in some patients during interval between preoperative chemoradiation and surgery, or in surgery or at immediate postoperative period. Methods : We reviewed a total of 139 patients who were treated by preoperative chemoradiation between January, 1995 and December, 2004, all of them had locally advanced rectal cancer. In work-up study for preoperative chemoradiation, no distant metastasis was proven by chest x-ray, abdominal and pelvic CT. All patients received the full scheduled dose of radiation (range, 4500- 5500 cGy). The radiation was administered in divided tractions over a five-week period. 5flurouracil (450 mg/㎡/day) and leucovorin (20 mg/㎡/day) were administered continuously on day 1-5 and 19-33. Interval between preoperative chemoradiation and surgery was within 48 weeks. Before surgery, all patients underwent chest x-ray, liver ultrasonography and pelvic CT to do restaging. Results : One lung metastasis, 1 inguinal lymph node metastasis, and 1 bone metastasis were identified by restaging period. Three hepatic metastasis, 1 peritoneal seeding, 5 paraaortic lymph node metastasis were identified in operation field. Two bone metastases were identified at immediate postoperative period within 3 months. The 3 patients with bone metastasis complained of shoulder pain or back pain and all of bone metastases were identified by bone scan. As a result, 14 patients(10.1%) were inadequately included to preoperative chemoradiation with conventional imaging study. All of them died within one and a half year. Conclusions : In conclusion, in order to select preoperative chemoradiation adequately in locally advanced rectal cancer, it seems that specific imaging study is necessary to confirm liver metastasis or peritoneal seeding of cancer precisely. In addition, bone scan is mandatory to work-up of preoperative chemoradiation, if patient complained of shoulder or back pain.

PREOPERATIVE CHEMORADIATION USING ORAL CAPECITABINE IN LOCALLY ADVANCED RECTAL CANCER

Kim, Jun-Sang,Kim, Jae-Sung,Cho, Moon-June,Song, Kyu-Sang,Yoon, Wan-Hee 충남대학교 암공동연구소 2003 암공동연구소 업적집 Vol.3 No.

Purpose: Capecitabine (Xeloda) is a new orally administered fluoropyrimidine carbamate that was rationally designed to exert its effect by tumor-selective activation. We attempted to evaluate the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced rectal cancer. Methods and Materials: Between July 1999 and March 2001, 45 patients with locally advanced rectal cancer (cT3/T4 or N+) were treated with preoperative chemoradiation. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrent with radiotherapy and consisted of 2 cycles of 14-day oral capecitabine (1650 mg/㎡/day) and leucovorin (20 mg/㎡/day), each of which was followed by a 7-day rest period. Surgery was performed 6 weeks after the completion of chemoradiation. Results: Thirty-eight patients received definitive surgery. Primary tumor and node downstaging occurred in 63% and 90% of patients, respectively. The overall downstaging rate, including both primary tumor and nodes, was 84%. A pathologic complete response was achieved in 31% of patients. Twenty-one patients had tumors located initially 5 cm or less from the anal verge; among the 18 treated with surgery, 72% received sphincter-preserving surgery. No Grade 3 or 4 hematologic toxicities developed. Other Grade 3 toxicities were as follows: hand-foot syndrome (7%), fatigue (4%), diarrhea (4%), and radiation dermatitis (2%). Conclusion: These preliminary results suggest that preoperative chemoradiation with capecitabine is a safe, well-tolerated, and effective neoadjuvant treatment modality for locally advanced rectal cancer. In addition, this preoperative treatment has a considerable downstaging effect on the tumor and can increase the possibility of sphincter preservation in distal rectal cancer.

Preoperative Chemoradiation Using Oral Capecitabine in Locally Advanced Rectal Cancer

Kim, Jun-Sang,Kim, Jae-Sung,Cho, Moon-June,Song, Kyu-Sang,Yoon, Wan-Hee 충남대학교 암연구소 2003 암연구소 업적집 Vol.3 No.-

Purpose: Capecitabine (Xeloda) is a new orally administered fluoropyrimidine carbamate that was rationally designed to exert its effect by tumor-selective activation. We attempted to evaluate the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced rectal cancer. Methods and Materials: Between July 1999 and March 2001, 45 patients with locally advanced rectal cancer (cT3/T4 or N+) were treated with preoperative chemoradiation. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrent with radiotherapy and consisted of 2 cycles of 14-day oral capecitabine (1650 mg/㎡/day) and leucovorin (20 mg/㎡/day), each of which was followed by a 7-day rest period. Surgery was performed 6 weeks after the completion of chemoradiation. Results: Thirty-eight patients received definitive surgery. Primary tumor and node downstaging occurred in 63% and 90% of patients, respectively. The overall downstaging rate, including both primary tumor and nodes, was 84%. A pathologic complete response was achieved in 31% of patients. Twenty-one patients had tumors located initially 5 cm or less from the anal verge; among the 18 treated with surgery, 72% received sphincter-preserving surgery. No Grade 3 or 4 hematologic toxicities developed. Other Grade 3 toxicities were as follows: hand-foot syndrome (7%), fatigue (4%), diarrhea (4%), and radiation dermatitis (2%). Conclusion: These preliminary results suggest that preoperative chemoradiation with capecitabine is a safe, well-tolerated, and effective neoadjuvant treatment modality for locally advanced rectal cancer. In addition, this preoperative treatment has a considerable downstaging effect on the tumor and can increase the possibility of sphincter preservation in distal rectal cancer.

Capecitabine-based Neoadjuvant Chemoradiation Therapy in Locally-advanced Rectal Cancer

최홍조,박기재,이태무,하상식,이호영,이형식 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.2

Purpose: The aim of the study was to evaluate the efficacy and the toxicity of preoperative treatment with capecitabine in combination with radiation therapy (RT) in patients with locally-advanced, resectable rectal cancer. Methods: Thirty-five patients with locally-advanced rectal cancer (cT3/4, N-/+) were treated with capecitabine (825 mg/m2,twice daily for 7 days/wk) and concomitant RT (50.4 Gy/28 fractions). Surgery was performed 6-8 wk after completion of the chemoradiation followed by 4-6 cycles of adjuvant capecitabine monotherapy (1,250 mg/m2, twice daily for 14 days every 3 wk). Results: The chemoradiation program was completed in all but 2 patients, for whom both capecitabine and RT were interrupted for 2 wk because of grade-3 diarrhea. A R0 resection under the principle of total mesorectal excision (low anterior resection, 26; intersphincteric resection, 6; abdominoperineal resection, 2) was performed in all but one patient with a low anterior resection with positive circumferential margin (R1). Primary tumor and node downstaging occurred in 57% and 60%of patients, respectively. The overall rate of downstaging, including both the primary tumor and node, was 77% (27 patients). A pathological complete response of the primary tumor was achieved in 4 patients (11%). No patient had grade-4 toxicity,and the only grade-3 toxicity developed was diarrhea in 2 patients (6%) during chemoradiation. During a median follow-up of 38 mo, distant metastases developed in 4 patients (multiple lung metastases, 2; aortocaval nodal metastases, 2), and another 2 patients showed local recurrence. The three-year disease-free survival was 83%. Conclusion: This study suggests that preoperative capecitabine-based chemoradiation therapy is an effective and safe treatment modality for the tratment of locally-advanced, resectable rectal cancer.

직장암에서 수술 전 방사선-화학요법 후 발생한 후기 합병증

이승현,이철민,안병권,백승언 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

OBJECTIVES: To compare the late complications after operations for rectal cancers with and without preoperative chemoradiation. METHODS: From January 2003 to December 2005, 55 patients underwent operation after preoperative chemoradiation for adenocarcinoma of the rectum. All of them received the full scheduled dose of radiation with concurrent chemotherapy. The interval between preoperative chemoradiation and surgery was 4-6 weeks. 47 patients who had tumors below 8 cm from the anal verge were enrolled into the study group (CRT group). During same period, we selected 153 patients who had adenocarcinoma of the rectum below 8cm from the anal verge, underwent surgery alone without postoperative radiotherapy non-CRT group). We compared the early and the late postoperative complications between the CRT group and the non-CRT group. RESULTS: Of the late complications, the incidence of anastomotic stricture was significantly higher in the CRT group (P = 0.018). The incidence of anal stricture was higher in the CRT group (P = 0.164). In the CRT group, 3 cases (17.6%) had failed to preserve the anal function due to moderate or severe anal stricture. Of the 3 cases, protective ileostomy was persistent in 2 cases, colostomy was performed in one case. Otherwise, the late complications of the CRT group were intestinal obstruction in 2 cases (4.3%), lymph edema in 2 cases (4.3%). CONCLUSION: In CRT group, failure of anal function preservation due to anastomotic stricture or anal stricture was more common and serious than non-CRT group. We emphasize the need for careful management for postoperative anal stricture after preoperative chemoradiation.

비인강암에서 동시 화학방사선요법과 단독 방사선치료요법의 비교

이주연,이동욱 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2

연구목적: 비인강암의 치료 방법 중 화학요법과 방사선치료의 동시병합요법의 효과를 알기 위하여 단독 방사선치료요법과 비교하여 보았다. 대상 및 방법: 1994년 1월부터 2002년 10월까지 충북대학교병원 이비인후과에서 비인강암으로 진단받고 계획된 근치적 방사선치료를 시행한 13명을 대상으로 후향적 분석을 시행하였으며, 방사선치료만을 시행하였던 6명의 환자들과 화학요법과 방사선치료의 동시병합요법을 시행하였던 7명의 환자들에 대하여 임상양상과 치료결과 등을 비교 분석하였다. 결과: 치료 후의 완치율은 동시 화학방사선치료군의 경우 85.7%, 방사선치료만을 받았던 환자군의 경우 50% 이었다. 동시화학방사선치료군의 경우 5년 생존률은 66.7%, 방사선치료만을 시행하였던 군의 경우의 5년 생존률은 43.6% 이었다(p=0.39). 또한 동시화학방사선치료군의 경우 3년 무병 생존률은 75.2%, 방사선치료만을 시행하였던 군의 3년 무병 생존률은 50.3% 이었다(p=0.26). 평균 추적 관찰 기간은 각각 41개월과 71개월이었다. 결론: 비인강암의 치료에 있어서 동시 화학방사선요법이 방사선치료 단독 요법보다 향상된 전체 생존률과 무병 생존률의 양상을 보였으나 통계학적으로는 의미가 없었으며, 향후 더 많은 수의 환자들을 대상으로 한 무작위 전향적 연구가 필요할 것으로 생각된다. Purpose: To determine the effectiveness of chemoradiation therapy in nasopharyngeal carcinoma by comparing with radiation therapy alone. Materials and methods: Between January 1994 and October 2002, thirteen patients with newly diagnosed and histologically proven nasopharyngeal carcinoma treated in Department of Radiation Oncology. Chungbuk National University Hospital were retrospectively reviewed. Six patients were treated with radiation therapy alone and 7 patients were treated with concurrent chemoradiation. Results: The complete response rate was 85.7% in chemoradiation group, and was 50% in radiation alone group. The 5 year overall survival rate for chemoradiation group was 66.7% and for radiation alone group was 43.6% (p=0.39). The 3 year disease free survival rate was 75.2% versus 50.3%, respectively (p=0.26). The mean follow up duration was 41 months versus 71 months, respectively. Conclusion: Analysis of the thirteen patients showed no significant difference in disease free survival and overall survival in two treatment groups. This retrospective analysis did not demonstrate benefit with concurrent chemoradiation than radiation alone in treatment of nasopharyngeal carcinoma, and a large randomized prospective study is needed.

Clinical Responses and Prognostic Indicators of Concurrent Chemoradiation for Non-small Cell Lung Cancer

이동수,김연실,강진형,이상남,김영균,안명임,한대희,유이령,왕영필,박재길,윤세철,장홍석,최병옥 대한암학회 2011 Cancer Research and Treatment Vol.43 No.1

Purpose To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC)patients treated with concurrent chemoradiation. Materials and Methods From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy). Results Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23complete responses. The median survival duration for the overall patient group was 17.6months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007),and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively. Conclusion Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.

Evaluation of the role of inflammatory blood markers in predicting the pathological response after neoadjuvant chemoradiation in patients with locally advanced rectal cancer

Shahram Manoochehry(Shahram Manoochehry ),Hamid Reza Rasouli(Hamid Reza Rasouli ),Fathollah Ahmadpour(Fathollah Ahmadpour ),Alireza Keramati(Alireza Keramati ) 대한방사선종양학회 2023 Radiation Oncology Journal Vol.41 No.2

Purpose: This study aimed to evaluate the role of inflammatory blood markers in predicting the pathological response rate after neoadjuvant chemoradiation (neo-CRT) in patients with locally advanced rectal cancer (LARC). Materials and Methods: In this prospective cohort study, we analyzed the data of patients with LARC who underwent neo-CRT and surgical removal of the rectal mass between 2020 and 2022 in a tertiary medical center. Patients were examined weekly during chemoradiation and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune inflammation index (SII) were calculated from weekly laboratory data. Wilcoxon signed-ranks and logistic regression analysis were utilized to determine whether any laboratory parameters during different time point assessments or their relative changes could predict the tumor response based on a permanent pathology review. Results: Thirty-four patients were recruited for the study. Eighteen patients (53%) achieved good pathologic response. Statistical analysis by Wilcoxon signed-ranks method indicated significant rises in NLR, PLR, MLR, and SII on weekly assessments during chemoradiation. Having an NLR over 3.21 during chemoradiation was correlated with the response on a Pearson chi-squared test (p = 0.04). Also, a significant correlation was found between the PLR ratio over 1.8 and the response (p = 0.02). NLR ratio over 1.82 marginally missed a significant correlation with the response (p = 0.13). On multivariate analysis, a PLR ratio over 1.8 showed a trend for response (odds ratio = 10.4; 95% confidence interval, 0.9–123; p = 0.06). Conclusion: In this study, PLR ratio as an inflammatory marker showed a trend in the prediction of response in permanent pathology to neo-CRT.

식도암에서의 동시화학방사선요법

이강규(Kang Kyoo Lee),박경란(Kyung Ran Park),이종영(Jong Young Lee),신현수(Hyun Soo Shin),이종인(Chong In Lee),장우익(Woo Ick Chang),심영학(Young Hak Shim) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.1

목 적 : 식도암의 생존율을 증가시키기 위해서 동시화학방사선요법의 전향적이고 비무작위적인 단일 연구를 시행하였고, 이 방법으로 치료된 환자들의 생존율 및 생존율과 관련된 예후인자와 치료와 관련된 합병증 등에 대해서 조사하였다. 재료 및 방법 : 경부 또는 흉부 식도에서 시행한 조직검사상에서 침윤성 암종으로 판정되었고, 원발병소가 식도 및 종격동에 국한되어 있으면서 림프절 전이가 없거나 영역림프절 또는 쇄골상와 림프절 등까지 전이되어 있는 환자들을 대상으로 하였다. 방사선치료는 7주에 걸쳐 5940cGy를 조사하였고, 2차례의 화학요법을 동시에 시행하였다. 화학요법은 5-FU와 mitomycin C를 사용하였고, 5-FU는 제 1일부터 제 5일과 제 29일부터 제 33일 사이에 각각 5일 동안 1000mg/m2/day의 용량으로 지속성 정주 하였고, mitomycin C는 제 1일에 8mg/m2의 용량을 일시주사하였다. 동시화학방사선요법을 시행한 후에 5-FU는 9주, 13주, 17주에 각각 5일 동안 1000 mg/m2/day의 용량으로 지속성 정주 하였고, cisplatin을 9주, 13주, 17주의 제 1일에 80mg/m2의 용량을 일시주사하였다. 결 과 : 본 연구에 1989년 11월부터 1995년 11월까지 식도의 편평상피세포암으로 진단된 44명의 환자가 등록되었다. 치료 후 환자의 59%가 완전관해 되었고, 41%에서 부분관해 되었다. 전체 환자의 1년, 2년, 5년 생존율은 각각 59%, 38%. 9.6%였다(중간생존기간 : 17개월). 생존율과 관련된 예후인자는 치료 후 완전관해 여부와 T병기였다. 완전관해된 26명의 환자 중 6명에서 국소재발 되었고, 3명은 원격재발 되었으며, 다른 1명에서는 국소재발과 원격재발이 동시에 나타났고, 나머지 2명은 재발 양상을 알 수 없었다. 3도 이상의 급성과 만성합병증 발생률은 각각 20%와 13.6%였으나, 합병증과 관련된 사망은 없었다. 결 론 : 본 연구에서의 동시화학방사선요법은 방사선단독치료를 시행하였던 다른 연구들에 비해서 중간생존기간의 증가를 보였고, 치료와 연관된 합병증 발생률의 증가를 보이지 않았다. 치료 후 완전관해된 환자들이 부분관해된 환자에 비해 생존율의 향상을 보였으며, 주 재발양상이 국소재발이므로, 향후 국소제어를 증진시키기 위한 노력이 필요한 것으로 생각된다. Purpose : To evaluate survival rate and prognostic factors affecting survival of patients with esophageal cancer treated with concurrent chemoradiation. Materials and Methods : Eligibility included biopsy proven invasive carcinoma of the cervical or thoracic esophagus, confined to esophagus and mediastinum with or without regional lymph node and supraclavicular lymph node, and ECOG performance status H0-H2. Patients received radiation therapy with 5940cGy over 7 weeks and chemotherapy, consisted of 5-FU(1000 mg/m2/day in continuous infusion for 5 days, days 1 to 5 and days 29 to 33) and mitomycin C(8mg/m2 intravenous bolus at day 1). After concurrent chemoradiation, maintenance chemotherapy was followed with 5-FU(1000 mg/m2/day in continuous infusion for 5 days at 9th, 13th, and 17th weeks) and cisplatin(80mg/m2 intravenous bolus at the first day of each cycle). Results : From November 1989 to November 1995, 44 patients were entered in this study. After treatment, complete response rate and partial response rate were 59% and 41%. Overall 1, 2, and 5-year survivals were 59%, 38%, and 9.6%(median 17 months). Prognostic factors affecting survival were response to treatment and T-stage. Among 26 complete responders, there were 6 local recurrences, 3 distant recurrences, 1 local and distant recurrence, and 2 unknown site recurrences. Acute and chronic complication rates with grade 3 or more were 20% and 13.6% and there was no treatment-related mortality. Conclusion : Concurrent chemoradiation, compared with historical control groups that treated with radiation alone, improved median survival and did not significantly increase treatment-related complications. Complete responders had longer survival duration than partial responders. Predominant failure pattern was local failure. So, efforts to improve local control should be proposed.

Long Term Outcomes of Preoperative versus Postoperative Concurrent Chemoradiation for Locally Advanced Rectal Cancer: Experience from Ramathibodi Medical School in Thailand

Darunikorn, Pichayada,Puataweepong, Putipun,Dhanachai, Mantana,Dangprasert, Somjai,Swangsilpa, Thiti,Sitathanee, Chomporn,Jiarpinitnun, Chuleeporn,Pattaranutaporn, Poompis,Boonyawan, Keeratikan,Chansr Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.16

Objectives: The study analyzed and compared the long term outcome in locally advanced rectal cancer treated with preoperative and postoperative concurrent chemoradiation (CCRT). Materials and Methods: A retrospective review of 105 patients with stage T3-T4 or regional lymph node positive adenocarcinoma of rectum treated with preoperative or postoperative CCRT at Ramathibodi Hospital during 2005 to 2010 was performed. The results of treatment were reported with 5-year overall survival (OS), 5-year locoregional recurrence free survival (LRFS), and toxicity according to preoperative versus postoperative concurrent chemoradiation (CCRT) groups. Results: Among 105 patients, 34 (32%) were treated with preoperative CCRT and 71 (68%) with postoperative CCRT. At the median follow-up time of 50.5 months (range 2-114 months), five-year OS and LRFS of all patients were 87% and 91.6%, respectively. The study found no difference in 5-year OS (81.7% vs 89.2 %) or LRFS (83.4% vs 95.1%) between preoperative versus postoperative CCRT. Seven cases of loco-regional recurrence were diagnosed, 4 (11.8%) after preoperative CCRT and 3 (4.2%) after postoperative CCRT. The recurrent sites were anastomosis in all patients. There was no significant factor associated with outcome after univariate and multivariate testing. Grade 3 or 4 acute and late complications were low in both preoperative and postoperative CCRT groups. Conclusions: Locally advanced rectum cancer patients experience good results with surgery and adjuvant concurrent chemoradiation.