직장암의 방사선 치료결과 및 실패양상

The Result and Failure after Adjuvant Postoperative Irradiation in Carcinoma of Recum

From Jan. 1982 to Dec. 1990, 77 patients with rectal cancer were treated with curative surgical resection followed by postoperative adjuvant irradiation alone or combined with chemotherapy at the Department of Radiation Oncology, Korea University Hospital (KUH). Fifty-four (54/77, 70.1%) patients underwent abdominoperineal resection, 20 (20/77, 26%) patients underwent low anterior resection, and 3 (3/77, 3.9%) patients had wide excision only. Thirty-nine (39/77, 50.5%) received sequential chemotherapy (2 cycles to 12 cycles). The 5-year survival rate for the entire group was 43%: 78.2% in B2+B3, 39.4% in stage C1+C2+C3. Survival rates decreased with increasing penetration of the bowel wall by tumor and the presence of regional lymph node metastasis. those patients survival who underwent an abdominoperineal resection also experienced a significant decrease in compared to low anterior resection (23.1% vs. 63.8% in 5-year survival, p<0.05). Local failure occurred in 15 (19.5%) out of the 77 patients overall, 1 (5.3%) of 19 in stage ㅠ2+B3, and 14 (24.1%) of 58 in stage C1+C2+C3. presacral area was most common site of local failufre (8/17, 47.1%). Distant faliure occurred in 13(16.9%) of 77 patients. The most frequent site of distant failure was the lung followed by the liver, the bone, and the brain. Combined locoregional and distant failure occurred in 2 (2.6%) of 77 patients. pathological confirmation of perirectal fat and/or regional lymph node involvement resulted in a singificant decrease in survival and local control.