Oxaliplatin-based Neo-adjuvant Concurrent Chemo-radiotherapy in Treating Locally Advanced Lower Rectal Cancer

局部侵犯性直腸癌之術前輔助性電化療，Oxaliplatin based

陳彥豪(Yen-Hao Chen) ； 王輝明(Hwei-Ming Wang) ； 陳周斌(Joe-Bin Chen) ； 趙德馨(Da-Shin Chou) ； 馬秀峰(Hsiu-Feng Mar) ； 陳周誠(Chou-Chen Chen) ； 蔣鋒帆(Fang-Fan Chiang) ； 涂嘉明(Chia-Ming Twu)

《中華民國大腸直腸外科醫學會雜誌》 21卷1期 (2010/03) Pp. 17-22

https://doi.org/10.6312/SCRSTW.2010.21(1).09820

摘要

目的　如何增加低位侵犯性直腸癌術後病理反應率及增加R0切除率，是外科手術之一大挑戰。本研究注重的是術前輔助性電化療額外加上Oxaliplatin在此類病患之效益及安全性。
方法　將本院2008年1月至2008年11月，22位局部侵犯性直腸癌病患接受術前輔助性電化療，Oxaliplatin based，與本院之2005年1月至2007年6月，43位局部侵犯性直腸癌接受術前輔助性電化療，Non-Oxaliplatin based 的病患進行比較。
結果　(1) Oxaliplatin based group共有19位病患接受直腸癌根除性切除手術，19位皆有病理反應，比率高達100%，其中病理完全反應率高達31.6%，與Non-Oxaliplatin base group相比有較高的病理反應率。(2) Oxaliplatin based group 其中18位有病理周圍邊緣無腫瘤侵犯之情形，R0 切除率爲94.7%，與Non-Oxaliplatin base group 相比有較高的R0切除率。(3) Oxaliplatin based group總住院天數明顯下降，且有較低的併發症發生率。
結論　本研究發現於低位侵犯性直腸癌時，Oxaliplatin based術前輔助性電化療，有較高的病理反應率，較高的R0切除率及較低的併發症發生率。

關鍵字

局部侵犯性直腸癌 ； 術前輔助性電化療 ； Oxaliplatin based ； R0切除率

並列摘要

Purpose. Lower advanced rectal cancer, for surgeons, is problematic. Neo-adjuvant concurrent chemo-radiotherapy, described in last decade, leads local control at high percentage of R0 resection and pathologic response rate with compactable results in our published journal.1 Addition of oxaliplatin to 5-FU/leucovorin has been proposed because of evidence of improved disease-free and overall survival in patients with stage III colon cancer. 2, 3 We hypothesized whether by adding Oxaliplatin to CCRT regimen, better results could be achieved.
Methods. From January 2008 to November 2008, 22 patients with locally advanced lower rectal cancer receiving Oxaliplatin-based Neo-adjuvant CCRT were enrolled for study group. From January 2005 to June 2007, 43 patients with locally advanced rectal cancer receiving non-Oxaliplatinbased Neo-adjuvant CCRT were enrolled for control group. Factors including circumferential margin and pathologic response rate were evaluated.
Results. Three patients, not receiving post-CCRT curative resection were excluded. Pathologic response rate was 100%; complete response rate: 31.6% & partial response rate: 68.4% respectively. Oxaliplatin based group had a better pathologic response rate versus non-Oxaliplatin based group (100% vs. 79.1%, p=0.047) and excellent results in complete pathologic response (31.6% vs. 11.6%, p=0.031) and an improved circumferential margin rate (94.7% vs. 90.7%, p=1.00). Oxaliplatin based group had shorter stays (9.00±3.96 vs. 11.47±4.75, p=0.003) and less anastomosis leakage (5.3% vs. 27.8%, p=0.075).
Conclusion. Oxaliplatin-based Neo-adjuvant CCRT gives locally advanced lower rectal cancer patients more favorable results without increasing complications.

並列關鍵字

Locally advanced rectal cancer ； Neo-adjuvant concurrent chemo-radiotherapy ； Pathologic response ； Circumferential margin