연세의대 / 배현우, 김남규*
Abstract
Background: The optimal treatment of locally advanced rectal cancer with synchronous liver metastases remains controversial. In this study, we aimed to evaluate the safety, efficacy, and oncologic outcomes of upfront chemotherapy and short-course radiotherapy with delayed surgery in patients with locally advanced rectal cancer and synchronous liver metastases.
Methods: Forty-four patients who underwent upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer (cT3/4, <2.0 mm from the mesorectal fascia) with synchronous liver metastases between January 2010 and June 2017 were reviewed retrospectively. Primary and metastatic liver lesions were resected with curative intent. Upfront chemotherapy and short-course radiotherapy were administered. Thereafter, restaging, surgery only, or additional chemotherapy followed by surgery was performed.
Results: At the time of initial diagnosis, 20 patients had <3 liver metastases; 24 patients had ≥3 liver metastases. Twenty-three patients had hemi-liver metastases; 21 patients had bilobar liver metastases. R0 resection of rectal lesions was achieved in 43 patients. Synchronous R0 resection of liver metastases was achieved in 41 patients. Postoperative complications (Clavien-Dindo Grade ≥ III) were noted in 5 patients. Grade 3/4 adverse events were observed in 26 patients. All adverse events were managed effectively with medication and supportive care. The 3-year overall survival and progression-free survival rates were 65.3% and 26.9%, respectively.
Conclusion: Upfront chemotherapy and short-course radiotherapy with delayed surgery appear to be safe and effective in patients with locally advanced rectal cancer and synchronous liver metastases without substantially increasing treatment induced morbidity.
Affiliations
Hyeon Woo Bae 1 , Ho Seung Kim 1 , Seung Yoon Yang 1 , Han Sang Kim 2 , Sang Joon Shin 2 , Jee Suk Chang 3 , Woong Sub Koom 3 , Nam Kyu Kim 4
1 The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
2 Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
3 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
4 The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: namkyuk@yuhs.ac.
편집위원
진단 시 간전이를 동반한 국소진행성 직장암에서 6-8주의 항암화학요법 후 1주일 간의 방사선치료를 시행한 다음 수술을 시행하는 프로토콜을 적용하여 치료한 결과를 분석한 논문
2022-01-04 17:35:26