- 期刊
Postoperative Chemotherapy Might be Indicated on Patients with Pathological Stage Ⅱ Rectal Cancer after Preoperative Concurrent Chemoradiotherapy
術後化學藥物治療對於接受手術前合併電療及化療的第二期直腸癌病人之影響
摘要
目的 對於直腸癌的病人，術前合併電療及化療可以增加腫瘤期數降底及腫瘤細胞完全消失的機會，這次的研究主要是要驗證這個假說，接受手術前合併電療及化療的第二期直腸癌病人，對於再接受手術後化學藥物治療是有好處的。 方法 從2000至2004年期間，共收集有99位臨床上為第二期及第三期的直腸癌病人，接受合併電療、化療及根除性手術。電療及化療包括放射線45 Gray共分20次，合併口服藥物Tegafur-uracil和leucovorin，術後的輔助性化學藥物治療，包括注射12次的5-FU和leucovorin，或是每個月口服化學藥物Tegafur-uracil和leucovorin三週，為期共六個月，術後病理為第三期的直腸癌病人，都會安排輔助性化學藥物，病人的基本特性及存活率分析是利用chi-square及log-rank的分析方法。 結果 病理為第二期的直腸癌病人，五年的總存活率及無疾病復發存活率分別為75%及57.1%，而病理為第三期的直腸癌病人，五年的總存活率及無疾病復發存活率分別為86.4%及65.7%，病理為第二期的直腸癌病人沒有接受化學藥物治療，比病理為第三期的直腸癌病人有接受化學藥物治療，五年的總存活率及無疾病復發存活率相對來說還要差一點(p=0.058 and 0.333)。 結論 是否病理為第二期的直腸癌病人需要接受化學藥物治療，還需要進一步大規模且前瞻性的研究來證實。
並列摘要
Purpose. Preoperative concurrent chemoradiotherapy for rectal cancer increases the incidence of down-staging and pathological complete response. This study examined the hypothesis that patients with pathological stage Ⅱ rectal cancer would benefit from postoperative adjuvant chemotherapy after preoperative concurrent chemoradiotherapy. Methods. Between July 2000 and December 2004, 99 patients with clinical stage Ⅱ and Ⅲ rectal cancer who received preoperative concurrent chemoradiotherapy followed by radical surgery were enrolled. Preoperative concurrent chemoradiotherapy involved a radiation dosage of 45 Gy in 20 fractions and oral tegafur-uracil and leucovorin. Regimens for adjuvant chemotherapy were infusional 5-fluorouracil (3000 mg/m^2) and leucovorin (150 mg/m^2) biweekly for 12 cycles or oral tegafur-uracil (300 mg/m^2/day) and leucovorin (60 mg/day) 3 weeks per month over a 6-month period. Adjuvant chemotherapy was arranged for patients with pathological stage Ⅲ cancer. Basic characteristics were analyzed using the chi-square test. Survival was examined with Kaplan-Meier curves and comparisons were performed using the log-rank test. Results. Five-year overall survival and disease-free survival percentages were 75.0 and 57.1 for patients with pathological stage Ⅱ, and 86.4 and 67.5 for patients with pathological stage Ⅲ, cancers, respectively. Patients with pathological stage Ⅱ rectal cancer who did not receive adjuvant chemotherapy had relatively poorer overall and disease-free survivals compared to those with pathological stage Ⅲ cancer who received adjuvant chemotherapy (p=0.058 and 0.333, respectively). Conclusion. Alarge prospective study is indicated to confirm the value of adjuvant chemotherapy for patients with pathological stage Ⅱ rectal cancer after concurrent chemoradiotherapy and radical surgery.