Interval between Surgery and Radiation Therapy Is an Important Prognostic Factor in Treatment of Rectal Cancer
3
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose The purpose of this study is to evaluate survival and prognostic factors for rectal cancer, including interval between surgery and radiation therapy after surgery, radiation therapy, and chemotherapy. Materials and Methods We conducted a retrospective study of 153 patients with rectal cancer who were treated with surgery, radiotherapy with/without chemotherapy at Keimyung University Dongsan Medical Center from January, 1988 to December, 2005. The study included 89 males and 64 females, with a median age of 56 years (range, 23 to 81 years). Tumor, node and metastasis (TNM) was I in 23patients, II in 39, and III in 91. Radiation therapy was performed on pelvic fields using a median dose of 54 Gy five days per week, 1.8 Gy once per day. Ninety two patients were treated with radiotherapy, 43 with concurrent chemo-radiation therapy and 18 with sequential therapy after surgery. The median follow-up period was 52 months (range, 4 to 272 months). The interval between surgery and radiation was 1-25 weeks (median, 5 weeks). Results Two-year and five-year overall survival rate was 64.7% and 46.4%, respectively. Two-year and five-year disease-free-survival (DFS) rate was 58.6% and 43.1%, respectively. Median DFS was 39 months. Loco-regional failure was evident in 10.5% of patients, 8.4% had distant metastasis,and 9.2% had both. In multivariate analysis, TNM stage and interval between surgery and radiation therapy (≤5 weeks vs. ＞5 weeks; 95% confidence interval, 1.276 to 2.877; hazard ratio, 1.916;p=0.002) were significant prognostic factors of DFS. Conclusion Survival rates for rectal cancer after surgery, chemotherapy, and radiation therapy were similar to those reported in previous studies. Starting radiation therapy as soon as possible after surgery,especially within the first five weeks after surgery, is suggested.
Abstract
Purpose The purpose of this study is to evaluate survival and prognostic factors for rectal cancer, including interval between surgery and radiation therapy after surgery, radiation therapy, and chemotherapy. Materials and Methods We conducted a retrospective study of 153 patients with rectal cancer who were treated with surgery, radiotherapy with/without chemotherapy at Keimyung University Dongsan Medical Center from January, 1988 to December, 2005. The study included 89 males and 64 females, with a median age of 56 years (range, 23 to 81 years). Tumor, node and metastasis (TNM) was I in 23patients, II in 39, and III in 91. Radiation therapy was performed on pelvic fields using a median dose of 54 Gy five days per week, 1.8 Gy once per day. Ninety two patients were treated with radiotherapy, 43 with concurrent chemo-radiation therapy and 18 with sequential therapy after surgery. The median follow-up period was 52 months (range, 4 to 272 months). The interval between surgery and radiation was 1-25 weeks (median, 5 weeks). Results Two-year and five-year overall survival rate was 64.7% and 46.4%, respectively. Two-year and five-year disease-free-survival (DFS) rate was 58.6% and 43.1%, respectively. Median DFS was 39 months. Loco-regional failure was evident in 10.5% of patients, 8.4% had distant metastasis,and 9.2% had both. In multivariate analysis, TNM stage and interval between surgery and radiation therapy (≤5 weeks vs. ＞5 weeks; 95% confidence interval, 1.276 to 2.877; hazard ratio, 1.916;p=0.002) were significant prognostic factors of DFS. Conclusion Survival rates for rectal cancer after surgery, chemotherapy, and radiation therapy were similar to those reported in previous studies. Starting radiation therapy as soon as possible after surgery,especially within the first five weeks after surgery, is suggested.
참고문헌 (23)
- Balslev I, "Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid : a randomized multicenter study", Cancer, 58, pp.22~28 (1986)
- Mohiuddin M, "Colon and rectum, In Perez and Brady’s principles and practice of radiation oncology. 5th ed", pp.1366~1382 (2008), Lippincott Williams and Wilkins
- Colorectal Cancer Collaborative Group, "Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials", Lancet, 358, pp.1291~1304 (2001)
- Krook JE, "Effective surgical adjuvant therapy for high-risk rectal carcinoma", N Engl J Med, 324, pp.709~715 (1991)
- Wolmark N, "Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum : National Surgical Adjuvant Breast and Bowel Project Protocol R-02", J Natl Cancer Inst, 92, pp.388~396 (2000)
- Fisher B, "Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer : results from NSABP protocol R-01", J Natl Cancer Inst, 80, pp.21~29 (1988)
- NIH consensus conference, "Adjuvant therapy for patients with colon and rectal cancer", JAMA, 264, pp.1444~1450 (1990)
- O'Connell MJ, "Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery", N Engl J Med, 331, pp.502~507 (1994)
- Vikram B, "Adjuvant radiation therapy in locally advanced head and neck cancer", CA Cancer J Clin, 33, pp.134~138 (1983)
- Douglass HO Jr, "Survival after postoperative combination treatment of rectal cancer", N Engl J Med, 315, pp.1294~1295 (1986)
- Gall FP, "Update of the German experience with local excision of rectal cancer", Surg Oncol Clin N Am, 1, pp.99~109 (1992)
- Nascimbeni R, "Risk of lymph node metastasis in T1 carcinoma of the colon and rectum", Dis Colon Rectum, 45, pp.200~206 (2002)
- "Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group", N Engl J Med, 312, pp.1465~1472 (1985)
- Tepper JE, "Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer : initial results of intergroup 0114", J Clin Oncol, 15, pp.2030~2039 (1997)
- Kim JS, "Adjuvant radiotherapy following total mesorectal excision for stage IIA rectal cancer: is it beneficial?", Int J Colorectal Dis, 25, pp.1103~1110 (2010)
- Moody JS, "Stage-specific survival differences associated with postoperative radiotherapy for gastrointestinal cancers", J Gastrointest Cancer, 39, pp.86~99 (2008)
- Greene FL, "AJCC cancer staging manual. 6th ed" (2002), Springer-Verlag
- Schild SE, "Postoperative adjuvant therapy of rectal cancer : an analysis of disease control, survival, and prognostic factors", Int J Radiat Oncol Biol Phys, 17, pp.55~62 (1989)
- Compton CC, "Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999", Arch Pathol Lab Med, 124, pp.979~994 (2000)
- Crucitti F, "Prognostic factors in colorectal cancer : current status and new trends", J Surg Oncol Suppl, 2, pp.76~82 (1991)
- de Campos-Lobato LF, "Neoadjuvant therapy for rectal cancer : the impact of longer interval between chemoradiation and surgery", J Gastrointest Surg, 15, pp.444~450 (2011)
- Tulchinsky H, "An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer", Ann Surg Oncol, 15, pp.2661~2667 (2008)
- Halperin EC, "The discipline of radiation oncology, In Perez and Brady’s principles and practice of radiation oncology. 5th ed", pp.48~50 (2008), Lippincott Williams and Wilkins