針對局部進行期或低位直腸癌病患施以手術前同步化學放射治療-臨床因素暨病理因子對治療預後的影響

Pre-operative concurrent chemoradiotherapy for patients with locally advanced or low rectal cancer-The impact of clinical parameters and pathologic characteristics on prognosis

黃鈞民(Chun-Ming Huang)

指導教授 ： 王照元

高雄醫學大學/醫學院/醫學研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00087

摘要

過去這幾年在台灣，大腸直腸癌的發生率已經快速地增加，目前已經是台灣第一常見的惡性腫瘤同時也是因癌症而死亡的第三個常見的原因。臨床上針對第Ⅱ及Ⅲ期的直腸癌病患，手術前同步化學放射治療不僅能降低術後局部復發率還可以有較高的機率保留肛門。化學放射治療後的病理分期與病患的無病存活率及總體存活率有相關，特別是在化學放射治療後癌細胞完全消失的病患，他們有很低的局部及遠端復發率。這幾年來我們仍然以原發性腫瘤侵犯的深度；局部淋巴結侵犯與否；以及是否出現轉移(TNM分期)來做為直腸癌病人術前接受同步化學放射治療的決定因子。本研究計畫的目的就是找出能夠預測化學放射治療後療效的相關因子，讓臨床醫師與病患選擇最適當的治療。這樣的個人化醫療相信能更進一步地提升直腸癌病人的預後。

關鍵字

直腸癌 ； 同步化學放射治療 ； 肛門保留手術 ； 神經旁侵犯

並列摘要

The incidence of colorectal cancer (CRC) in Taiwan has been rapidly increasing in the past few years, and CRC is the second most common cancer and also the third leading cause of cancer death in Taiwan. For locally advanced rectal cancer (T3-4 or N1-2), preoperative chemoradiotherapy (CCRT) has been demonstrated to achieve a lower local recurrence rate and good sphincter preservation rate. Several prospective and retrospective analyses suggest that pathological stage of disease after preoperative CCRT has a significant prognostic impact on disease-free and overall survival. In particular, the subgroup of patients who achieve a complete pathological response has a very low risk of local or distant recurrence. Traditionally, it is usually depends on TNM stage to determine whether patient receives preoperative CCRT or not. This proposal is aimed to discover clinical factors that can increase the power to predict the efficacy of preoperative CCRT.

並列關鍵字

rectal cancer ； concurrent chemoradiotherapy ； sphincter-preserving surgery ； perineural invasion

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