Comparison between Pre-Operative Short Course Radiotherapy and Long Course Chemoradiotherapy in Patients with Locally Advanced Rectal Cancers

侵襲性直腸癌接受術前短程放射治療與長程化學與放射治療的比較

賴家玄(Chia-Hsuan Lai) ； 陳文政(Wen-Cheng Chen) ； 葉重宏(Chong-Hong Yeh) ； 黃文詩(Wen-Shih Huang) ； 靳志堅(Chih-Chien Chin) ； 郭益宏(Yi-Hung Kuo) ； 王正儀(Jeng-Yi Wang) ； 陳妙芬(Miao-Fen Chen)

《放射治療與腫瘤學》 16卷3期 (2009/09) Pp. 165-177

https://doi.org/10.6316/TRO/200916(3)165

摘要

目的：這個研究的目的是分析對於侵襲性直腸癌的病患，術前短程放射治療與長程化學與放射治療，是否就可切除性，腫瘤反應和肛門括約肌保留而言提供相近的效果。
材料與方法：在西元2003年12月至2008年8月期間，88個侵襲性直腸癌的病患接受術前5×5 Gy短程放射治療合併立即性手術或是接受術前同步化學放射治療（放射治療劑量爲50.4 Gy，單次劑量1.8 Gy；同時加上兩個療程的5-fluorouracil和leucovorin）合併延遲性手術。
結果：在88個侵襲性直腸癌的病患中，38個接受術前短程放射治療，50個接受術前同步化學放射治療。所有病人都有接受手術。手術後邊緣乾淨的比例分別是97%和98%，肛門括約肌保留的比例分別是100%和98%。接受術前同步化學放射治療的病患比接受術前短程放射治療的病患有較高的比例有腫瘤反應(CCRT 40% vs. SCRT 29%, p=0.28)。追蹤時間的中位數是19個月。在追蹤期間，6個病患(7%)有局部復發，16個病患(18%)發生遠端轉移。2年整體存活率在兩個族群之間並沒有統計上的差異(SCRT-96.0% vs. CCRT-86.9%, p=0.48)。就無病存活率而言，接受術前短程放射治療的病患比接受術前同步化學放射治療的病患有較佳的2年無病存活率(SCRT-82.4% vs. CCRT-62.4%, p=0.06)。
結論：就可切除性和肛門括約肌保留而言，對於第II-III期的直腸癌病患，術前短程放射治療和術前同步化學放射治療提供了相近的效果。接受術前同步化學放射治療則有較高的腫瘤反應比例。兩種治療方式對於長期的存活率和腫瘤控制率的效果則需要更長的追蹤時間才能了解。

關鍵字

直腸癌 ； 術前放射治療 ； 術前短期放射治療 ； 術前同步化學放射治療

並列摘要

Purpose: The aim of this study is to determine whether preoperative short course radiotherapy (SCRT) or long course chemoradiotherapy (CCRT) offers similar results in terms of the resectability, tumor response and sphincter preservation in patients with locally advanced (stage II-III) rectal cancer.
Materials and Methods: Between December 2003 and August 2008, 88 patients with rectal adenocarcinoma (clinical staged T3-4N0-2M0) received either SCRT or CCRT were enrolled. In the SCRT group, patients received pre-operative 5×5 Gy with immediate surgery. In the CCRT group, patients received a total dose of 50.4 Gy (1.8 Gy per fraction) concomitantly with two courses of 5-fluorouracil and leucovorin followed by delayed surgery.
Results: Among the 88 patients, 38 received SCRT and 50 received CCRT. All patients received curative surgery. A R0 resection was performed in 97% and 98% of patients received SCRT and CCRT respectively. Sphincter preservation was achieved in 100% and 98% of patients received SCRT and CCRT respectively. A higher tumor response rate was observed in the CCRT group (downstage 40%) as compared with SCRT group (downstaging 29%). With a median follow-up time of 19 months, local failure developed in 6 of 88 (7%) and distant metastases occurred in 16 of 88 (18%). The 2-year overall survival (OS) are comparable between these two groups (OS: SCRT-96.0% vs. CCRT-86.9%, p=0.48). In terms of disease-free survival (DFS), patients in the SCRT group have borderline significant better 2-year DFS as compared with CCRT group (DFS: SCRT-82.4% vs. CCRT-62.4%, p=0.06).
Conclusion: Pre-operative SCRT and CCRT are equally effective in terms of the resectability and sphincter preservation in stage II-III rectal cancer. A higher tumor response (downstaging and complete tumor response) was noted in the CCRT group. The long term results of overall tumor control and survivals between these two groups still need longer follow-up time to disclose.

並列關鍵字

Rectal cancer ； Preoperative radiotherapy ； Pre-operative short-course radiotherapy ； Concurrent chemoradiotherapy