Neoadjuvant Short-course Radiotherapy or Concurrent Chemoradiotherapy Followed by Radical Colectomy in Locally Advanced Colon Cancer Patients

局部侵犯型大腸癌病患接受短程放射線治療或同步化學放射治療併廣泛性大腸癌切除成果分析

謝孟樵(Meng-Chiao Hsieh) ； 賴家玄(Chia-Hsuan Lai) ； 郭益宏(Yi-Hung Kuo) ； 靳志堅(Chih-Chien Chin) ； 黃文詩(Wen-Shih Huang)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 123-133

https://doi.org/10.6312/SCRSTW.202009_31(3).10833

摘要

Purpose. Locally advanced colon cancer (LACC) is usually defined as having a large tumor size, infiltrating tumor, or adhering to adjacent structures. Frequently, LACC should be considered as having an oncologically unresectable status. Neoadjuvant short-course radiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT) has could be a choice for locally advanced rectal cancer. However, the role of neoadjuvant SCRT or CCRT in the treatment of LACC remains unclear. The aim of this study was to analyze neoadjuvant SCRT or CCRT outcome in LACC patients. Methods. We retrospectively reviewed LACC patients from our institutional database between January 2008 to December 2018. Patients'demo-graphic data, radiotherapy (RT) toxicity, surgical results, pathologic out-comes following SCRT or CCRT, 5-year overall survival (OS) rates and disease-free survival (DFS) rates were collected for analysis. Results. A total of 19 patients were enrolled. All patients had a clinical T4a or T4b stage and excluded clinical T3 stage with 14 patients (73.7%) were N2 positive lymph nodes status. There was no toxicity in the SCRT group. For the CCRT group, the major toxicity was gastrointestinal (GI) syndrome, and all seven patients (100%) had a grade 1-2 adverse effect. A multivisceral resections were required in seven patients (35.8%). R0 re-section was 78.9%, pathologic complete response (pCR) rate was 5.3%, and local recurrence rate was 5.3% in stage III patients. The 5-year OS and DFS were 91.7% and 83.3% in stage III patients, respectively. Conclusions. Our study demonstrates that neoadjuvant SCRT or CCRT followed by radical colectomy are feasible and safe treatment in LACC patients.

關鍵字

Locally advanced colon cancer ； Colon cancer ； Short-course radiotherapy ； Concurrent chemoradiotherapy ； Surgery

並列摘要

背景：局部侵犯型大腸癌通常定義為很大的腫瘤體積，腫瘤侵犯或是沾黏到鄰近的組織或器官。一般來說，局部侵犯型大腸癌常常是無法將腫瘤切除乾淨的疾病。目前來說，直腸癌病患接受前輔助性短程放射線治療或同步化學放射治療已經成為標準的癌症治療步驟選項。但是，局部侵犯型大腸癌病患接受前輔助性短程放射線治療或同步化學放射治療的腳色定位至今仍然不清楚。本篇研究的目的在分析大腸癌病患接受前輔助性短程放射線治療或同步化學放射治療的成果分析。方法：我們回溯性分析本院於2008年1月到2018年12月期間，診斷為局部侵犯型大腸癌及前輔助性短程放射線治療或同步化學放射治療的病患。病患的基本資料，放射線治療毒性，手術成果，病理報告結果，5年整體存活率和5年無疾病存活率資料都被收集起來加以分析結果。結果：本研究總共收錄19位病人。所有病人T分期為T4a期或T4b期，沒有T3期。14位病人（73.7%）為臨床N2淋巴結陽性。接受短程放射線的病人沒有發生放射治療毒性。接受同步化學放射治療病患則100%發生1至2級的腸胃道毒性副作用。需要多重臟器切除佔7位病人（35.8%），組織邊緣切除陰性結果佔78.9%，病理完全反應者僅佔5.3%，局部復發機率為5.3%。第3期病患平均5年整體存活率和5年無疾病存活率分別為91.7% 和83.3%。結論：我們的研究指出局部侵犯型大腸癌病患接受前輔助性短程放射線治療或同步化學放射治療併廣泛性大腸癌切除是可行且安全的。

並列關鍵字

局部侵犯型大腸癌 ； 大腸癌 ； 短程放射線治療 ； 同步化學放射治療 ； 手術

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