Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Pathological and Clinical Effects of Preoperative Chemoradiation in Rectal Cancer

직장암의 수술 전 항암화학방사선치료 후 병리학 및 임상적 효과 분석

  • Song, Jin-Ho (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Jang, Hong-Seok (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Kim, Yeon-Sil (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Chung, Su-Mi (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Son, Seok-Hyun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Kang, Jin-Hyeong (Department of Medical Onocology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine) ;
  • Youk, Eui-Gon (Department of Colorectal Surgery, Daehang Hospital) ;
  • Lee, Doo-Seok (Department of Colorectal Surgery, Daehang Hospital) ;
  • Lee, Suk-Hi (Department of Clinical Pathology, Daehang Hospital) ;
  • Yoon, Sei-Chul (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine)
  • 송진호 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실) ;
  • 장홍석 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실) ;
  • 김연실 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실) ;
  • 정수미 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실) ;
  • 손석현 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실) ;
  • 강진형 (가톨릭대학교 의과대학 서울성모병원 종양내과학교실) ;
  • 육의곤 (대항병원 외과) ;
  • 이두석 (대항병원 외과) ;
  • 이숙희 (대항병원 병리과) ;
  • 윤세철 (가톨릭대학교 의과대학 서울성모병원 방사선종양학교실)
  • Received : 2010.12.07
  • Accepted : 2011.01.13
  • Published : 2011.03.30
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Abstract

Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1 %. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.

목적: 수술 전 항함화학방사선치료는 국소 진행된 직장암에서 표준치료로 알려져 있다. 이 연구는 동시 항암화학 방사선치료를 받은 국소 진행된 직장암 환자의 생존율 및 병기하향률에 영향을 미치는 인자들을 분석하였다. 대상 및 방법: 2004년 3월부터 2008년 8월까지 수술 전 항암화학방사선치료를 받은 국소 진행된 직장암 환자 33명을 대상으로 하였다. 모든 환자는 전 골반 방사선조사를 시행하였으며 28명(84.8%)은 동시적 소조사야 추가 방사선치료, 5명(15.2%)은 조사영역축소 방사선치료를 실시하였다. 총 방사선량은 50.4 Gy이었으며, 5-fluorouracil를 동시 투여하였다. 추적관찰 기간은 중앙값 24.2개월(9.8~64.7개월)이었다. 결과: 33명 중 31명(93.9%)에서 수술이 시행되었으며, 24명(72.7%)은 항문괄약근보존술, 7명(21.2%)은 복회음부 절제술이 시행되었다. 3년 생존율과 무병생존율은 각각 78.8%, 63.4% 이었다. 무병생존율에 영향을 미치는 인자로 수술 후 병리학적 소견이 중요하였다. 병리학적 N 병기(p=0.001), 절제면 침윤 여부(p=0.029) 및 분화도(p=0.030)가 통계학적으로 의미 있게 영향을 미치는 인자였다. 종양 크기 (p=0.081), 림프혈관과 신경주위 침윤여부(p=0.073) 모두 영향을 마치는 인자로서의 경향성을 보였다. 한편, 수술 전 임상 소견으로는 임상적 T 병기만이 유의한 결과를 보였다(p=0.018). 병리학적 완전관해율은 9.1%였으며, T병기하향률은 30.3%, N 병기하향률은 72.7%로 나타났다. 단변량 분석에서 항암화학방사선치료 후 수술까지의 기간 및 임상적 T 병기가 의미 있는 병기하향의 예측인자로 분석되었다(p=0.029, 0.027). 치료 전 carcinoembryonic antigen 수치는 예측인자의 경향성을 보였다(p=0.068). 결론: 국소 진행된 직장암 환자의 생존율은 임상적 병기보다 수술 후 병리학적 소견에 더 의존되었다. 그러므로 수술전 항암화학방사선치료로 병기하향을 얻는 것이 의미가 있으며, 수술까지의 기간, 임상적 T 병기가 이러한 병기하향을 예측하는 인자였음을 알 수 있었다.

Keywords

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