Preoperative Weekly 24-hour Infusion of High-dose 5-Fluorouracil and Leucovorin (HDFL) with Concurrent Radiation for T3, T4 Rectal Cancer on a Outpatient Basis

術前以每週二十四小時持續滴注高劑量5-Fluorouracil加Leucovorin同步合併放射療法在門診非住院方式下治療T3，T4直腸癌病人

尤昭傑(Jau-Jie You) ； 張東浩(Tung-Hao Chang) ； 鍾智淵(Chih-Yuang Chung) ； 陳自諒(William Tzu-Liang Chen) ； 張正雄(Cheng-Shyong Chang) ； 劉幕台(Mu-Tai Liu) ； 蕭光宏(Koung-Hung Hsiao) ； 陳宏彰(Hong-Chang Chen) ； 黃燈明(Ting-Ming Huang)

《中華民國大腸直腸外科醫學會雜誌》 16卷1期 (2005/03) Pp. 7-16

https://doi.org/10.6312/SCRSTW.2005.16(1).09401

摘要

目的　我們報告使用持續滴注高劑量5-fluorouracil(5-FU)加leucovorin(LV)合併放射治療於門診治療T3，T4直腸癌病人的經驗。
方法　共有28個T3，T4直腸癌患者在門診施行手術前化學放射治療。其中男性佔18位女性佔10位。平均年齡爲56歲（28-74歲）。病人在五週半內接受每週一次24小時持續滴注高劑量5-FU LV，合併每週5次共28次骨盆腔放射治療5040cGy。治療結束後約6週，所有病人皆接受根除性手術。
結果　有3位病人是第三級毒性腹瀉。中性白血球減少合併發燒毒性反應有一位病人，此病人因而中斷治療。其他病人皆爲較低等級之毒性反應。有18位病人達到腫瘤期別下降；其中8位病人完全緩解，病理標本中沒有殘存的腫瘤細胞。
開刀距離化學放射治療結束平均5.7週。11位病人接受腹腔鏡手術。低位直腸切除併直接吻合有9位。J形大腸袋狀成形術併肛門吻合及大腸橫狀整形袋狀成形術併肛門吻合分別施行於2位及8位病人。在13位低位直腸癌患者中有6位施行肛門保留手術。手術併發症是22.22%。重大手術併發症含2位吻合端滲漏及1位吻合端狹窄。四年存活率是81.62%；四年無疾病之存活率是69.37%。平均存活時間是53.09個月。有5位病人後來發生遠端轉移其中2位先以局部轉移表現。
結論　使用每週一次24小時持續滴注高劑量5-FU LV合併放射療法可使用於門診治療直腸癌病人，且有較少血液毒性反應。之後才施行根除性手術仍然能達到較佳之腫瘤期別下降，甚至完全緩解。因此可以有較好之肛門保留率，可降低局部復發及增進存活率。

關鍵字

直腸癌 ； 手術前化學放射治療

並列摘要

Background. Because of high local recurrent with traditional approaches for advanced rectal cancer, we investigated preoperative radiation-chemotherapy (5 -fluorouracil and leucovorin) for patients with T3, T4 rectal cancer.
Methods. Twenty-eight outpatients (18men, 10women; median age 56.5years, range 28-74) with T3, T4 rectal adenocarcinoma received preoperative chemoradiation therapy (CCRT). The 24-hour infusions of 2600 mg/m^2 5-fluorouracil and 300 mg/m^2 leucovorin were given concurrently with radiation (5O4OcGy, 28 fractions over 5.5 weeks). Prior to curative total mesorectal excision (mean interval from CCRT, 5.7 weeks). Twelve cases received laparoscopic surgery, including one converted to an open procedure. Low anterior resection with J-pouch, transverse coloplasty pouch, or straight end-to-end anastomosis was done for two eight and nine patients, respectively.
Results. Acute toxicity consisted of three patient with grade 3 diarrhea and one patient with neutropenic fever who discontinued chemotherapy (latter excluded from analysis). A total of 18 (62.96%) of 27 patients achieved tumor downstaging, and 8 (29.63%) had pathologic complete remission. Sphincter-preserving surgery was achieved in 6 (46.15%) of 13 low rectal cases. Surgical complication rate was 22.22%, including anastomosis dehiscence (n=2) and anastornosis stenosis (n=1). At 28.9 months median follow-up, the four-year overall survival and disease-free survival rates were 81.62% and 69.37% (mean overall survival time, 53.09 months). Five patients developed distal metastasis; two initially had local recurrence.
Conclusions. Outpatient CCRT decreases hematologic toxicity while showing promise in improving outcomes such as pathologic remission and tumor downstaging, sphincter preservation, local recurrence/metastasis, and survival.

並列關鍵字

Rectal cancer ； Preoperative chemoradiation