국소 진행성 직장암 환자에서 수술 전 화학 방사선 치료 후 종양 반응 정도에 따른 종양학적 결과에 대한 고찰 = Oncologic Result as According to Tumor Regression Grade after Neoadjuvant Chemoradiation Therapy in Locally Advanced Rectal Cancer

다국어 초록 (Multilingual Abstract)

Purpose: The effects of neoadjuvant chemoradiation therapy
(NCRT) in cases of locally advanced rectal cancer include
tumor downstaging with respect to a curative resection
and a decreasing incidence of local recurrence.
The aim of this study is to evaluate the oncologic results
according to the tumor regression grade (TRG) after NCRT
and radical surgical resection in cases of locally advanced
rectal cancer. Methods: From 1999 to 2003, 140 consecutive
patients, who suffered from locally advanced rectal
cancer (T3 or T4, or lymph node positive) were enrolled
in this study. They all received neoadjuvant chemoradiation
therapy and a radical resection. Chemotherapy was based
on 5-fluorouracil (5-FU), and the total radiation dose was
5,040 cGy over 6 weeks. A radical surgical resection, including
a total mesorectal excision, was done 6 to 8 weeks
after the completion of NCRT. We classified patients into
subgroups by using the TRG; then, we investigated the
overall and the disease-free survival rates and the local
recurrence and the distant metastasis rates. Results: One
hundred twenty-six (126, 90%) patients responded to radiation
therapy. According to the TRG, the numbers of nonresponders
(Grade I, NR), partial responders (Grade II,
PR), and patients who went into complete remission (Grade
III, CR) were 14 (10%), 98 (70%), and 28 (20%), respectively.
The overall survival (OS) and the disease-free survival
(DFS) rates for 3 years (n=140) were 91.43% and 74.29%,
and the rates for 5 years (n=117) were 81.20% and
67.52%, respectively. While there was no significant difference
in the 3-year OS or DFS between the three groups
stratified by TRG (P=0.1136, P=0.1215), the 5-year OS
and DFS showed a statistical difference (P=0.0485,
P=0.0458). Furthermore, the 3-year OS and DFS rates
(P=0.0451, P=0.0458), as well as the 5-year OS and DFS
rates (P=0.0139, P=0.0131) were significantly better for
patients in the CR group than for the other patients. Still,
no statistical significance differences existed between the
CR group and the non-CR groups or between the TRG
groups in terms of the local recurrence and the distant
metastasis rates (P=0.447, P=0.271). Conclusions: Any
tumor response group that shows complete Rremission
after NCRT and radical surgical resection has an oncologic
benefit in overall survival and disease- free survival in our
study.

다국어 초록 (Multilingual Abstract)

Purpose: The effects of neoadjuvant chemoradiation therapy
(NCRT) in cases of locally advanced rectal cancer include
tumor downstaging with respect to a curative resection
and a decreasing incidence of local recurrence.
The aim of this study is to evaluate the oncologic results
according to the tumor regression grade (TRG) after NCRT
and radical surgical resection in cases of locally advanced
rectal cancer. Methods: From 1999 to 2003, 140 consecutive
patients, who suffered from locally advanced rectal
cancer (T3 or T4, or lymph node positive) were enrolled
in this study. They all received neoadjuvant chemoradiation
therapy and a radical resection. Chemotherapy was based
on 5-fluorouracil (5-FU), and the total radiation dose was
5,040 cGy over 6 weeks. A radical surgical resection, including
a total mesorectal excision, was done 6 to 8 weeks
after the completion of NCRT. We classified patients into
subgroups by using the TRG; then, we investigated the
overall and the disease-free survival rates and the local
recurrence and the distant metastasis rates. Results: One
hundred twenty-six (126, 90%) patients responded to radiation
therapy. According to the TRG, the numbers of nonresponders
(Grade I, NR), partial responders (Grade II,
PR), and patients who went into complete remission (Grade
III, CR) were 14 (10%), 98 (70%), and 28 (20%), respectively.
The overall survival (OS) and the disease-free survival
(DFS) rates for 3 years (n=140) were 91.43% and 74.29%,
and the rates for 5 years (n=117) were 81.20% and
67.52%, respectively. While there was no significant difference
in the 3-year OS or DFS between the three groups
stratified by TRG (P=0.1136, P=0.1215), the 5-year OS
and DFS showed a statistical difference (P=0.0485,
P=0.0458). Furthermore, the 3-year OS and DFS rates
(P=0.0451, P=0.0458), as well as the 5-year OS and DFS
rates (P=0.0139, P=0.0131) were significantly better for
patients in the CR group than for the other patients. Still,
no statistical significance differences existed between the
CR group and the non-CR groups or between the TRG
groups in terms of the local recurrence and the distant
metastasis rates (P=0.447, P=0.271). Conclusions: Any
tumor response group that shows complete Rremission
after NCRT and radical surgical resection has an oncologic
benefit in overall survival and disease- free survival in our
study.

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