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題名 | The Long-term Clinical Outcomes of Neoadjuvant Concurrent Radiochemotherapy for Treatment of Locally Advanced Colon Cancer=對於侵犯性大腸直腸癌使用術前同步化學放射治療之長期追蹤 |
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作者 | 陳彥成; 李京錞; 蘇偉智; 張琮琨; 蔡祥麟; 黃敬文; 馬政仁; 王照元; Chen, Yen-cheng; Li, Ching-chun; Su, Wei-chih; Chang, Tsung-kun; Tsai, Hsiang-lin; Huang, Ching-wen; Ma, Cheng-jen; Wang, Jaw-yuan; |
期刊 | 中華民國大腸直腸外科醫學會雜誌 |
出版日期 | 20191200 |
卷期 | 30:4 2019.12[民108.12] |
頁次 | 頁187-198 |
分類號 | 416.245 |
語文 | eng |
關鍵詞 | 侵犯性大腸癌; 同步化學放射治療; 長期追蹤; Advanced colon cancer; Neoadjuvant radiochemotherapy; Long-term outcomes; |
中文摘要 | 目的:侵犯性大腸癌的治療至今仍是一項挑戰,患者的預後多不甚理想。然而使用術前同步化學放射治療,有機會提高腫瘤切除率並提升存活率,本研究旨在探究術前同步化學放射治療之療效、毒性、病理反應和長期存活時間。方法:我們收入了36名,在2012年1月至2017年1月被診斷為侵犯性大腸癌的患者,藉由回溯病歷資料,分析其治療成果和治療細節,所有的患者都接受了術前同步化學放射治療,化學治療所使用的藥物包括了奧沙利鉑,亞葉酸和5-氟尿嘧啶,即所謂的FOLFOX。結果:T和N降階的比率分別是63.9%和86.1%。貧血是最常見的三級不良反應(18.89%),其次是白血球低下(16.67%)。絕大多數的不良反應都可以用藥物控制症狀。在36名患者中,有34名在同步化學放射治療後,順利接受手術切除腫瘤,2名患者腫瘤仍無法切除。有一名患者同時有3顆侵犯性大腸癌,並成功手術切除。8名患者(22.2%)達到完全病理反應。羅吉斯迴歸分析發現局部復發和遠端轉移是兩項不利於存活的預測因子。整體5年存活率為66%,無疾病存活率為43%。病理完全反應和無淋巴結侵犯的患者有較長的整體存活率和無疾病存活率,但均未達統計學意義。在病理完全反應的患者,局部復發率為0,但有3名患者(37.5%)出現遠端轉移。結論:我們的研究成果顯示術前同步化學放射治療,可以安全地使用在侵犯性大腸癌的患者身上,達到治療效果。有病理完全反應和無淋巴結侵犯的患者,其存活時間較長。對於病理完全反應的患者,沒有觀察到局部復發,但有機會出現遠端轉移。 |
英文摘要 | Purpose. Locally advanced colon cancer remains a challenge of radical resection, because it is associated with poor oncologic outcomes. Neo-adjuvant concurrent chemoradiotherapy can improve the curative resection rate and patient's survival. This study evaluated the related treatment efficiency, toxicity, pathologic features and long-term survival period. Methods. We reviewed 36 patients diagnosed with locally advanced colon cancer and who received treatment between January 2012 and January 2017. We retrospectively analyzed the treatment details and outcomes from medical records. All patients received neoadjuvant concurrent chemoradiotherapy. The neoadjuvant chemotherapy regiment included oxaliplatin, folinic acid and 5-fluorouracil. Results. The proportion of T and N downstaging was 63.9% and 86.1% respectively. Anemia (18.89%) was the most common Grade 3 adverse events, followed by leukopenia (16.67%). Most of the adverse events were manageable through symptomatic treatment. Of 36 patients, 34 underwent surgery after concurrent chemoradiotherapy, and the remaining 2 patients were still unresectable. However, 1 patient had 3 synchronous locally advanced colon cancer and received tumor resection successfully. A logistic regression analysis demonstrated that local recurrence and distant metastasis were independent predictor of survival (all p < 0.05). Estimated 5-year overall survival rate was 66% and disease-free survival rate was 43%. Eight patients (22.2%) presented a pathologic complete response. Patients with pathologic complete response or no lymph node invasion on specimen had longer overall survival and disease-free survival periods, but without significance (both p > 0.05). For patients with pathologic complete response, the local recurrence rate was 0, but 3 patients (37.5%) developed distant metastasis subsequently. Conclusions. Neoadjuvant chemoradiotherapy was a feasible and safe treatment strategy for locally advanced colon cancer, and patients with pathologic complete response and no lymph node invasion on specimen had longer survival periods. No local recurrence was noted in patients with pathologic complete response, but with distant metastasis risk. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。