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  • [Oncol Lett.] Efficacy of hypofractionated preoperative chemoradiotherapy in rectal cancer.

    전남의대 / 조익준, 남택근*

  • 출처
    Oncol Lett.
  • 등재일
    2023 May 3
  • 저널이슈번호
    25(6):263. doi: 10.3892/ol.2023.13849. eCollection 2023 Jun.
  • 내용

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    Abstract
    The efficacy and toxicity of hypofractionated preoperative chemoradiotherapy (HPCRT) combined with oral capecitabine was evaluated in patients with rectal cancer. HPCRT was delivered by intensity-modulated radiotherapy of either 33 Gy to the whole pelvis or 35 Gy in 10 fractions to the primary tumor and 33 Gy to the surrounding pelvis. Surgery was performed 4-8 weeks after HPCRT completion. Oral capecitabine was administered concurrently. A total of 76 patients were eligible for this study, and patient numbers in clinical stages I, II, III and IVA were 5, 29, 36 and 6, respectively. Tumor response, toxicity and survival were analyzed. A total of 9/76 patients (11.8%) achieved a pathological complete response. Sphincter preservation was achieved in 23/32 (71.9%) and 44/44 (100%) of patients with a distal extent from the anal verge of ≤5 and >5 cm, respectively. A total of 28/76 patients (36.8%) achieved tumor-downstaging and 25/76 (32.9%) achieved nodal (N)-downstaging. The 5-year disease-free survival (DFS) and overall survival rates were 76.5% and 90.6%, respectively. In the multivariate analysis for DFS, pathological N stage and lymphovascular space invasion were notable prognostic factors. A total of 6 patients in stage IVA underwent salvage treatments for lung or liver metastasis after HPCRT completion, and all 6 were alive at the last follow-up. Only 4 patients experienced grade 3 postoperative complications. No grade 4 toxicities were observed. HPCRT of 33 or 35 Gy in 10 fractions showed similar results to those of long-course fractionation. This fractionation scheme could be beneficial for patients with early stage disease, locally advanced rectal cancer, simultaneous distant metastasis requiring early intervention or for patients who wish to avoid multiple hospital visits.

     

     

    Affiliation

    Ick Joon Cho 1, Jae-Uk Jeong 1, Taek-Keun Nam 1, Yong-Hyub Kim 1, Ju-Young Song 1, Mee Sun Yoon 1, Sung-Ja Ahn 1, Shin Haeng Cho 1
    1Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanamdo 58128, Republic of Korea.

  • 키워드
    IMRT; hypofractionation; preoperative chemoradiotherapy; rectal cancer.
  • 편집위원

    직장암의 수술전 항암방사선치료 시 기존의 잘 알려진 long-course (5-6주) RT와 short-course (1주) RT 외에 33-35 Gy/10회 시행하는 세기조절방사선치료(IMRT)의 안정성과 효용성을 발표한 연구로, long-course RT와 비슷한 안정성과 효용성을 보이면서도 방사선치료 횟수, 기간, 치료비용을 단축시킬 수 있음을 확인했음.

    2023-07-04 14:54:12

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