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| 題 名 | Outcomes of Neoadjuvant Chemoradiation Therapy for Locally Advanced Rectal Cancer: The Effect of Preoperative Chemoradiotherapy Followed by Additional Chemotherapy on Advanced Rectal Cancer=局部侵犯性直腸癌的術前輔助電化療的預後報告:術前輔助電化療結束後,額外追加化療之治療成效 |
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| 作 者 | 張筆凱; 饒樹文; 吳昌杰; 李家政; 李才宇; 蕭正文; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
| 卷 期 | 24:3 2013.09[民102.09] |
| 頁 次 | 頁80-86 |
| 分類號 | 416.245 |
| 關鍵詞 | 局部侵犯性直腸癌; 術前輔助電化療; 降低腫瘤分期; 局部復發率; Advanced rectal cancer; Neoadjuvant concurrent chemoradiotherapy; Tumor downstaging; Local recurrence; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:局部侵犯性直腸癌患者經術前輔助電化療後,大部分患者可達到腫瘤縮小及降低腫瘤分期等效果。對其腫瘤之局部復發率也有明顯之降低的效果。病理上的病理完全反應率大約是百分之八到十九,根據其使用之化療藥物及放療劑量不同而有差異。方法:回溯性病例回顧於2005年一月至2008年十二月,經診斷為直腸癌且接受術前輔助電化療及腫瘤根治性手術的患者。術前輔助電化療的處方為高劑量5FU(每體表面積2000毫克)靜脈滴注24小時加上leucovorin(每體表面積500毫克)靜脈滴注兩小時,及總計量4500cGy的放射治療。病人術前輔助電化療結束後6-8週接受手術,但化療持續至手術前兩週。結果:61位患者中有31個男性,30女性。平均年齡為67.6歲。大部分的患者對於術前輔助電化療的反應良好,有降低腫瘤分期。只有15位患者腫瘤對術前輔助電化療沒有反應。對於術前輔助電化療後沒有反應的患者,與術前輔助電化療後腫瘤期別下降的患者相較之下,有較低的根治性切除比例與較高的局部復發率,並達到統計學上意義。結論:術前輔助電化療對於局部侵犯的直腸癌患者,可提供腫瘤期別下降及腫瘤縮小之效果。術前的化療的藥物,劑量及持續期間並無定論,根據我們的經驗,持續化療至術前兩週是安全無虞的,而其對於病理上腫瘤完全緩解機率的影響則需更多的研究證實。 |
| 英文摘要 | Background. In most cases of locally advanced rectal cancer, neoadjuvant chemoradiation therapy (CCRT) reduces tumor size and results in histopathologic downstaging. This results in improved long-term oncologic outcomes. Pathologic complete remission ranges from 8% to 19%, depending on the regimen and dose of chemotherapy and/or radiotherapy.Patients and Methods. We retrospectively reviewed the medical records of patients diagnosed with rectal adenocarcinoma who were receiving neoadjuvant CCRT and curative surgery in our hospital from January 2005 to December 2008. The regimen of neoadjuvant CCRT included a high weekly dose of 5-fluorouracil (5-FU) (2000 mg/m^2 5-FU for 24 hours plus 500 mg/m^2 leucovorin intravenously for 2 hours), concurrent with radiotherapy at a total dose of 4500 cGy. Chemotherapy was continued until 2 weeks before surgery, and patient underwent surgery within 6 to 8 weeks of completing CCRT.Result. In total, 61 patients, including 31 males and 30 females with an average age of 67.6 years were examined. Most patients had a good response to neoadjuvant CCRT and experienced tumor downstaging. Only 15 patients did not experience a change in disease stage after neoadjuvant CCRT. The non-responding group had a significantly lower curative resection rate (R0 resection rate) (p=0.04) and higher local recurrence rate (p=0.03) than the responding group.Conclusion. Neoadjuvant CCRT for locally advanced rectal cancer can result in tumor downstaging and shrinkage. The regimen, dosage, and duration of chemotherapy were variable. Our results demonstrate that the administration of chemotherapy until 2 weeks before curative surgery was safe, however, the effect on the pathological complete response rate requires additional study. |
本系統中英文摘要資訊取自各篇刊載內容。