Treatment Results of Rectal Adenocarcinoma after Curative Surgery and Recurrent Disease after Salvage Treatment

原發性直腸腺癌經根除手術後及其復發經拯救性治療的治療結果

曾顯群(Hsien-Chun Tseng) ； 詹建勝(Jian-Sheng Jan)

《放射治療與腫瘤學》 5卷2期 (1998/06) Pp. 81-88

https://doi.org/10.6316/TRO/199805(2)81

摘要

目的：本文主要分析原發直腸腺癌的經根除手術治療的結果以及討論復發直腸腺癌之拯救性治療扮演的角色。
材料與方法：台中榮民總醫院放射腫瘤科自1980年至1995年癌病登記有90位原發直腸腺癌患者接受放射治療的登記資料，但手術過程中發現有骨盆腔以外擴散的的患者、確定診斷時接受姑息性手術者、及治療記錄不完整者皆不列入本文分析，有效分析者共有60位患者，所有病患均接受了根除手術，輔助治療採用放射線治療或化學治療則主要由外科醫師決定；腫瘤復發藉由理學檢查、影像檢查如電腦斷層或磁振造影。大腸鏡檢、癌胚抗原(CEA)、或是超音波檢查的結果來確定。本文使用Kaplan-Meier方法自手術日開始算起分析存活的時間。
結果：這60位患者之兩年及五年的全體存活率分別是63及33%，一般復發率是88%，術後到局部復發平均時間是26個月，術後到遠處轉移平均時問是21個月。僅有5位患者的單獨骨盆腔復發能夠接受再度治癒性的手術切除。直腸癌復發接受姑息性治療的患者，其中值存活時間是6個月，7位直腸癌復發的患者僅接受拯救性放射線治療，自診斷出腫瘤復發日算起，接受拯救性手術的患者之存活中值時問為16個月，對於僅接受拯救性放射治療的患者，其存活中值時間為85個月。
結論：原發直腸腺癌的患者僅接受根除性手術，仍有很高的復發率，有少數局部復發的患者可再次施行根除性的手術而獲得較長的存活時間。

關鍵字

直腸腺癌 ； 根除手術 ； 拯救性治療

並列摘要

Purpose: This study was to analyze the treatment results of our patients with rectal adenocarcinoma receiving curative surgery ± radiotherapy and discuss the role of salvage treatment for recurrence.
Materials and Methods: A total of 90 patients with rectal adenocarcinoma who received radiotherapy from 1980 to 1995 were registered at Department of Radiation Oncology, Taichung Veteran General Hospital. The patients who were found to have extrapelvic extension at operation, palliative surgery at diagnosis, and incomplete data were excluded. Sixty patients were analyzable. All these 60 patients received potentially curative surgery at diagnosis. Adjuvant therapy with radiotherapy or chemotherapy was mainly decided by the surgeon. Recurrence of tumor was documented by physical examination, imaging studies such as CT scan or MRI, colonosoopy, CEA, or sonography. The salvage treatment of recurrent tumor included reoperation with curative or palliative intent, radiotherapy alone or with chemotherapy. Analysis of survival was calculated from the date of operation using Kaplan-Meier method.
Results: Of these 60 patients 2- and 5-year overall survival rate were 63% and 33%, respectively. Overall recurrence rate was 88%. The mean loco-regional recurrence time was 26 months vs. 21 months for distant metastasis. Only 5 patients with isoloated pelvic recurrence can be salvaged by reoperation with curative intent. The patients with recurrent cancer receiving palliative surgery survived at a median of 6 months. Seven patients with recurrent disease were salvaged with radiotherapy only. The patients with salvage surgery survived at a median of 16 months after diagnosis of recurrence vs. 8.5 months for patients with salvage radiotherapy only. Clinical variables such as age, gender, stage, tumor location, and tumor size had no statistically significant impact on survival.
Conclusion: There was substantially high recurrence rate for patients with even potentially curative resection of primary rectal adenocarcinoma. A minority of patients with isolated local recurrence can be salvaged by aggressive reoperation with a relatively long survival.

並列關鍵字

Rectal adenocarcinoma ； Curative surgery ； Salvage treatment