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  • [Eur J Surg Oncol.] Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases

    [Eur J Surg Oncol.] Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases

    연세의대 / 배현우, 김남규*

  • 출처
    Eur J Surg Oncol.
  • 등재일
    2021 Nov
  • 저널이슈번호
    47(11):2814-2820. doi: 10.1016/j.ejso.2021.05.018. Epub 2021 May 12.
  • 내용

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    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.

     

  • 키워드
    Locally advanced rectal cancer; Short course radiotherapy; Synchronous liver metastasis; Upfront chemotherapy.
  • 연구소개
    국소 진행된 직장암 (LARC) 은 근치적 절제율 향상 목적으로 수술전 장기간 화학 방사선 치료를 선행 하는 것이 표준화된 방법이다. LARC 와 간전이가 발견시 치료 방법에 대해서는 과거로부터 다양한 치료 방법이 제시 되어 왔다. 고용량 단기 방사선치료 ( 5Gy x 5 days) 의 경험이 유럽에서 많이 보고 되고 있는 상황에서 본원 다학제 진료에서 치료 법 (fig.2) 을 개발하였다. 이 치료 방법을 2010년부터 2017년 까지 53명을 대상으로 전향적으로 적용하였다, 치료법의 안정성과 효과에 대한 임상적 결과 보고이다. 43 명에서 직장암과 간전이 에 대한 근치적 절제가 시행 되었다. 기본적으로 간전이에 대한 전신 화학 요법 시행후 단기 방사선 치료 (LARC) 이후 delayed surgery ( 직장암 치료 효과 기대 및 수술후 합병증 예방) 수술 기다리는 동안 다시 화학 요법 시행 하는 것이 치료 계획 임. 수술후 문합부 합병증 등은 5명에서 관찰 되었고 선행 치료 중 grade 3 이상 부작용은 26명에서 관찰되었음. 3년 overall survival 65.3%, progression free survival 26.9% 이었다. 본원에서 제안한 샌드위치 protocol 은 대부분 환자들이 잘 견디었고 치료 효과도 좋았다. 장기간 관찰이 필요하다고 생각한다.
  • 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

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