Neoadjuvant Long Course CCRT Significantly Increases Disease Free Survival among Pathological Stage III Rectal Cancer Patients as Compared to Short Course RT Alone

手術前長程化學與放射治療較手術前短程放射治療對於第三期直腸癌病患的無病存活率有顯著的改善

廖俊凱(Chun-Kai Liao) ； 葉建裕(Chien-Yuh Yeh) ； 曾雁明(Yen-MingTsang) ； 林耕平(Geng-Pin Lin) ； 唐瑞平(Rei-Ping Tang) ； 江支銘(Jy-Ming Chiang) ； 游耀東(Yau-Tong You) ； 謝寶秀(Pao-Shiu Hsieh) ； 蔡文司(Wen-Sy Tsai) ； 洪欣園(Hsin-Yuan Hung) ； 游正府(Jeng-Fu You) ； 蔣昇甫(Sum-Fu Chiang) ； 賴正洲(Cheng-Chou Lai) ； 陳進勛(Jinn-Shiun Chen)

《中華民國大腸直腸外科醫學會雜誌》 28卷1期 (2017/03) Pp. 18-26

https://doi.org/10.6312/SCRSTW.2017.28(1).10519

摘要

Purpose. Both pre-operative short course radiotherapy and long course radiotherapy with concurrent chemotherapy have been used with the purpose of better local control and survival for locally advanced rectal cancer. However, the selection of patients for these two treatment modalities has remained unclear. Methods and Materials. Patients diagnosed with locally advanced rectal adenocarcinoma from 2002/1/1 to 2006/12/31 and have received complete preoperative short course radiotherapy or long course chemoradiotherapy followed by curative surgery were included. These patients were followed up until 2009/12/31. Variants between gender, age, tumor location, initial CEA level, and tumor differentials were compared. Overall survival, disease free survival, local recurrent rate and distant metastasis rate were also compared by Log Rank test. Results. Tumor location (63.4% vs. 81.0% for low rectum, p = 0.049) was the only difference between short course and long course subgroups in terms of clinicopathological characteristics. Significant differences are found between groups according to whether there is a presence of pathological proven lymph node metastasis or not. The overall survival (89.3% vs. 62.2% 5 years survival, p = 0.009) is better in the short course group only for the subgroup without lymph node metastasis. As for the subgroup with lymph node metastasis, better diseases free survival (27.8% vs. 64.7% 5 years survival, p = 0.018) and metastasis free rate (26.8% vs. 76.5% 5 years survival, p = 0.003) and a trend of significant difference in overall survival (p = 0.059) is noted in the long course CCRT group. However, there is no significant difference for local recurrence (83.0% vs. 87.5% 5 years survival, p = 0.557). Conclusions. To achieve better disease free survival, long course CCRT should be considered for patients with middle and low rectal cancer with lymph node metastasis. However, for patients without evidence of lymph node metastasis, short course radiotherapy may achieve the same disease control.

關鍵字

Concurrent chemoradiotherapy ； Radiotherapy ； Advanced rectal cancer

並列摘要

目的 對於局部晚期直腸癌的病患，為了達到更好的局部控制及存活率，無論是術前短程放射治療或是長程同步放化療皆被使用中。然而，如何選擇這兩個治療方法仍無定論。方法 我們蒐集了2002 年1 月1 日至2006 年12 月31 日於林口長庚醫院診斷為局部晚期直腸癌的病患，所有病患皆接受完整術前短程放射治療或是長程同步放化療並接受根除性手術，術後追蹤日期至2009 年12 月31 日。變異項目如病患的性別、年齡、術前CEA 濃度及腫瘤位置皆被收集分析。總生存率，無病生存率，局部復發率和遠處轉移率也由統計分析比較。結果 在臨床病理特徵方面，腫瘤位置是短程治療及長程治療唯一的差異項 (低位直腸63.4% vs. 81.0%, p = 0.049)。針對淋巴結轉移與否的次族群分析存在許多統計上的差異。對於沒有淋巴結轉移的次族群，短程治療有較好的總生存率 (五年存活率89.3% vs. 62.2,p = 0.009)。對於有淋巴結轉移的次族群，長程同步放化療則有較好的無病生存率 (五年存活率27.8% vs. 64.7%, p = 0.018)，較低的遠處轉移率 (Metastasis free rate 26.8% vs.76.5%, p = 0.003) 及趨向有較好的總生存率 (p = 0.059)。對於局部復發率，兩者並無顯著差異 (83.0% vs. 87.5%, p = 0.557)。結論 基於我們的研究，對於中低位直腸癌且有淋巴結轉移的病患，為了達到更好的無病生存率，術前長程同步放化療是可以考慮的治療方式。對於沒有淋巴結轉移的病患，術前短程放療則與術前長程同步放化療有同樣的疾病控制。

並列關鍵字

同步放化療 ； 放射治療 ； 局部晚期直腸癌

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