TREATMENT OUTCOMES OF NEOADJUVANT CCRT IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER -A SINGLE INSTITUTIONAL REPORT

術前同步化放療於局部侵犯性直腸癌患者之治療成效：單一機構之報告

李芃逸(Peng-Yi Lee) ； 簡君儒(Chun-Ru Chien) ； 陳自諒(William Tzu-Liang Chen) ； 柯道維(Tao-Wei Ke) ； 郭于誠(Yu-Cheng Kuo) ； 張伸吉(Sheng-Chi Chang) ； 林膺峻(Ying-Jun Lin)

《放射治療與腫瘤學》 23卷2期 (2016/06) Pp. 85-97

https://doi.org/10.6316/TRO/201623(2)85

摘要

目的：評估局部侵犯性直腸癌患者接受術前同步化放療之治療成效。材料與方法：回顧本院自西元2006年至2013年間，新診斷之局部侵犯性直腸癌，且於手術前接受同步化放療的病例。排除診斷時已有轉移及最終沒有在本院接受手術者。放療總劑量中位數為5040cGy，常用的同步化療藥物為Capecitabine或Tegafur & Uracil。術前放化療結束至手術間隔時間中位數為8周。使用Kaplan-Meier方法分析整體存活率（OS）、癌症存活率（CSS）、骨盆腔無復發存活率（PRFS）、與無遠端轉移存活率（DMFS）。並分析影響病理完全緩解率（pCR）之因子及不同手術方式的預後。結果：166位病人被納入本研究，追蹤時間中位數為3.03年。5年的OS和CSS分別為73%及78%。無骨盆腔復發和無遠端轉移之存活時間中位數分別為2.6年及2.2年。病理完全緩解率為11.45%。化療藥物之選擇對存活率及病理完全緩解率無顯著影響。病患接受肛門保留手術之比例為77%，在距離anal verge小於5 cm、5到10 cm、與超過10 cm之患者，接受肛門保留手術的比例分別為59%、87%、100%。腹腔鏡與傳統開腹手術之比較顯示：接受腹腔鏡手術之患者有較少的骨盆腔內復發（11.1% v.s 25.6%, p= .036），較少的術中失血量（174 cc v.s 309 cc, p= .012），及較短的住院天數（8 days v.s 13 days, p= .000）。在存活分析方面，OS、CSS、PRFS及DMFS於接受兩種術式之病人間，皆無統計上顯著差異。結論：術前同步化放療為治療局部侵犯性直腸癌患者之有效方法。Capecitabine與Tegafur & Uracil這兩種藥物均可合併術前放射線治療使用。內視鏡腫瘤切除手術與開腹腫瘤切除手術相較有相同的治療成果但相對較低的手術併發症。

關鍵字

術前同步化放療 ； 直腸癌 ； 治療成效

並列摘要

Introduction : The purpose of this study is to evaluate preliminary outcomes in locally advanced rectal cancer patients who underwent neoadjuvant concurrent chemoradiotherapy (CCRT). Material and Method : From 2006 to 2013, 166 patients with newly diagnosed clinical stage II or III rectal cancer who received neoadjuvant CCRT were identified (cT2- 3=155, cT4=11, cN+=93). All of them received external beam radiotherapy (EBRT) with median dose of 5040 cGy (4400 - 5400 cGy). The regimens of chemotherapy combined with radiation were Capecitabine (47%), Tegafur & Uracil (40%) and others. Median duration from the end of neoadjuvant CCRT to surgery was 56 days (21 - 173 days). All radical surgery were done in a total mesorectal excision (TME) fashion. The end points of this study included overall survival (OS), cancer-specific survival (CSS), pelvic recurrence-free survival (PRFS), and distant metastasis-free survival (DMFS). We also analyzed factors associated with pathological complete response (pCR) and outcomes between different surgical procedures. Result : After a median follow-up duration of 3.03 years (0.22 - 8.16 years), 5-year OS rate was 73%, 5-year CSS rate was 78%, median PRFS was 2.6 ± 2 years, and median DMFS was 2.2 ± 2 years. There were no differences in OS (p= .776) and CSS (p= .717) between patients receiving Capecitabine or Tegafur & Uracil combined with radiation. We achieved pCR rate of 11.45%, and ratio of receiving anal-preservation surgery was 77% (59%, 87%, 100% for lower third, middle third, and upper third tumor, respectively). In subgroup analysis, laparoscopic surgery group had lower pelvic recurrence rate (11.1% v.s 25.6%, p= .036), less intra-operative blood loss (mean, 174 cc v.s 309 cc, p= .012), and shorter hospital stay (mean, 8 days v.s 13 days, p= .000). The 5-year OS rate was 78% for laparoscopic surgery group and 59% for open surgery group respectively (p = .126), the 5-year CSS rate was 80% and 72% (p= .572), median PRFS was 2.2 years and 4.6 years (p= .672), and median DMFS was 2 years and 3.5 years (p= .549). Conclusion : Neoadjuvant CCRT followed by surgery is a feasible way to treat locally advanced rectal cancer, and the 5-year OS rate was 73% in the current study. Capecitabine and Tegafur & Uracil are reasonable choices as concurrent regimens. Laparoscopic surgery is recommended due to lower surgical morbidities and noninferiority of outcomes.

並列關鍵字

Neoadjuvant concurrent chemoradiotherapy ； Rectal cancer ； Treatment outcomes