국소진행된 직장암에서의 수술전 방사선치료 단독군과 방사선치료와 항암제 병용치료군의 치료성적

Treatment Results of Preoperative Radiotherapy Alone vs. Preoperative Radiotherapy and Chemotherapy in Locally Advanced Rectal Cancer

Purpose : to assess the efficacy and toxicity of the preoperative radiotherapy with or without chemotherapy in locally advanced rectal cancer. Methods : Forty three patients (clinically diagnosed stages above or equal to Astler-Coller stage B2 without distant metastasis) were assigned to preoperative radiotherapy alone arm (n=16) or combined preoperative radiotherapy and chemotherapy arm (n=27). Preoperative radiotherapy of 4500 cGy to whole pelvis +/- 540 cGy boost to primary site and concurrent chemotherapy of 2 cycles of 5-FU (500mg/m²) and leucovorin (20mg/m²) were used. fifteen patients of preoperative radiotherapy alone arm and 19 of combined arm received surgical resection after preoperative treatment. Results : During the preoperative treatment, no significant complication was developed in both groups. Pathologic results were as follows; complete remission 1, B1 1, B2 6, C1 2, C2 5 in preoperative radiotherapy alone arm and complete remission 2, B1 8, B2 4, C2 3, D 2 in combined arm. Postoperative complications were delayed perineal wound healing in three patients, intestinal obstruction in three patients (one managed by conservative medical treatment, two by surgical treatment). conclusion : The combined preoperative radiotherapy and chemotherapy arm was more affective in pathological response and lymph node negativity rate than the preoperative radiotherapy alone arm. Both the preoperative radiotherapy alone arm and the combined arm were generally well tolerated and did not result in an increased postoperative morbidity.