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  • 2026년 02월호
    [Yonsei Med J .] Long-Term Outcomes of Long-Course Chemoradiotherapy vs. Short-Course Radiotherapy Followed by Consolidation Chemotherapy in Rectal Cancer

    연세의대 / 이종민, 조민수*

  • 출처
    Yonsei Med J .
  • 등재일
    2025 Dec
  • 저널이슈번호
    66(12):891-896.
  • 내용

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    Abstract
    Purpose: Previous studies have demonstrated that short-course radiotherapy (SCRT), followed by consolidation chemotherapy (CCT), produces oncologic outcomes comparable to those of long-course chemoradiotherapy (LCRT). However, more recent long-term data have raised concerns regarding the durability of these benefits. This study aimed to assess the long-term surgical and oncologic outcomes of SCRT with CCT vs. LCRT, using data from the ESCORT trial.

    Materials and methods: This comparative study included 62 patients with locally advanced rectal cancer. Patients in the SCRT group (n=27) were prospectively enrolled in the ESCORT trial (NCT03676517), a single-arm phase II study conducted from 2018 to 2020. They received five daily fractions of 5 Gy, followed by two cycles of XELOX, and surgery after 4 weeks. A matched cohort of 35 patients who underwent LCRT during the same period was retrospectively identified from institutional records.

    Results: With a median follow-up of 4.75 years for the SCRT group and 4.94 years for the LCRT group, the 5-year overall survival rates were similar between the groups (SCRT: 100% vs. LCRT: 97.1%, p=0.382). The 5-year disease-free survival (DFS) rates were 83.6% for SCRT and 70.3% for LCRT (p=0.237). In multivariable analysis, SCRT was not associated with inferior DFS (hazard ratio, 0.53; 95% confidence interval, 0.14-2.04). Delayed anastomosis-related complications occurred at similar rates (18.5% vs. 20.0%; p=0.884).

    Conclusion: SCRT with CCT demonstrated long-term oncologic outcomes and surgical safety comparable to those of LCRT, supporting its role as a viable alternative, particularly in resource-constrained healthcare settings.

     

     

    Affiliations

    Jong Min Lee 1, Jeehye Lee 1, Taehyung Kim 1, Nam Kyu Kim 1, Min Soo Cho 2
    1Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
    2Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. nagase96@yuhs.ac

     

    이전 연구의 장기 결과 입니다. 참고 링크

    https://www.rmwebzine.re.kr/newshome/mtnmain.php?mtnkey=articleview&mkey=scatelist&mkey2=55&aid=7008

     

  • 키워드
    Rectal neoplasm; chemoradiotherapy; diseases free survival; neoadjuvant therapy.

  • 편집위원

    국소진행된 직장암에서 수술전 치료로 단기간 방사선치료(SCRT, 25 Gy/5회)와 장기간방사선치료(LCRT, 50-50.4 Gy/25-28회)를 비교한 연구가 많이 발표되었고, 그 결과는 대체로 비슷한 것으로 알려져 있으나 최근 RAPIDO trial에서 장기 국소재발률은 SCRT가 다소 높은 것으로 알려져 이 부분에 대한 관심이 높아진 바 있습니다.
    한편, 본 연구 발표 기관에서 수행했던 ESCORT trial은 SCRT와 공고항암요법이 LCRT에 비해 병리학적 완전관해율(pCR)이 상대적으로 높으면서 치료비용과 환자편의성 측면에서 장점이 있었음을 2023년에 보고한 것인데, 당시 결과는 단기 결과(short-term outcomes)였던 반면, 본 연구는 동일 연구의 장기 결과를 보고한 것입니다. SCRT 4.75년, LCRT 4.94년의 중앙추적관찰기간 동안 장기 예후 및 수술 안정성 측면에서 대등한 결과를 보였으며, RAPIDO trial에서 나타난 SCRT의 국소제어율 측면의 열등성도 관찰되지 않았다고 보고하고 있습니다. 이에 따라 SCRT는 여전히 효과적이고 안전하다는 근거를 보여줬다는 것이 흥미롭습니다.

    덧글달기2026-02-04 10:21:38

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