Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer: Treatment Outcomes and Analysis of Prognostic Factors
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose This study was designed to investigate the long-term oncologic outcomes for locally advanced rectal cancer patients after treatment with preoperative concurrent chemoradiotherapy followed by total mesorectal excision, and to identify prognostic factors that affect survival and pathologic response. Materials and Methods From June 1996 to June 2009, 135 patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy followed by total mesorectal excision at Kyung Hee University Hospital. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival. Results The median follow-up time was 50 months (range, 4.5 to 157.8 months). After preoperative chemoradiotherapy, sphincter preservation surgery was accomplished in 67.4% of whole patients. A complete pathologic response was achieved in 16% of patients. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for all patients was 82.7% and 75.7%, 76.8% and 71.9%, 67.9% and 63.3%, respectively. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for pathologic complete responders was 100% and 100%, 100% and 88.9%,95.5% and 95.5%, respectively. In the multivariate analysis, pathologic complete response was significantly associated with overall survival. The predictive factor for pathologic complete response was pretreatment clinical stage. Conclusion Preoperative chemoradiotherapy for locally advanced rectal cancer resulted in a high rate of overall survival, sphincter preservation, down-staging, and pathologic complete response. The patients achieving pathologic complete response had very favorable outcomes. Pathologic complete response was a significant prognostic factor for overall survival and the significant predictive factor for a pathologic complete response was pretreatment clinical stage.
Abstract
Purpose This study was designed to investigate the long-term oncologic outcomes for locally advanced rectal cancer patients after treatment with preoperative concurrent chemoradiotherapy followed by total mesorectal excision, and to identify prognostic factors that affect survival and pathologic response. Materials and Methods From June 1996 to June 2009, 135 patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy followed by total mesorectal excision at Kyung Hee University Hospital. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival. Results The median follow-up time was 50 months (range, 4.5 to 157.8 months). After preoperative chemoradiotherapy, sphincter preservation surgery was accomplished in 67.4% of whole patients. A complete pathologic response was achieved in 16% of patients. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for all patients was 82.7% and 75.7%, 76.8% and 71.9%, 67.9% and 63.3%, respectively. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for pathologic complete responders was 100% and 100%, 100% and 88.9%,95.5% and 95.5%, respectively. In the multivariate analysis, pathologic complete response was significantly associated with overall survival. The predictive factor for pathologic complete response was pretreatment clinical stage. Conclusion Preoperative chemoradiotherapy for locally advanced rectal cancer resulted in a high rate of overall survival, sphincter preservation, down-staging, and pathologic complete response. The patients achieving pathologic complete response had very favorable outcomes. Pathologic complete response was a significant prognostic factor for overall survival and the significant predictive factor for a pathologic complete response was pretreatment clinical stage.
참고문헌 (25)
- Shivnani AT, "Preoperative chemoradiation for rectal cancer : results of multimodality management and analysis of prognostic factors", Am J Surg, 193, pp.389~393 (2007)
- Sauer R, "Preoperative versus postoperative chemoradiotherapy for rectal cancer", N Engl J Med, 351, pp.1731~1740 (2004)
- Yeo SG, "Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer : long-term outcomes andprognostic significance of pathologic nodal status(KROG 09-01)", Ann Surg, 252, pp.998~1004 (2010)
- Wheeler JM, "Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer : correlation with rectal cancer regression grade", Dis Colon Rectum, 47, pp.2025~2031 (2004)
- Kao PS, "The impact of preoperative chemoradiotherapy on advanced low rectal cancer", J Surg Oncol, 102, pp.771~777 (2010)
- Kapiteijn E, "Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer", N Engl J Med, 345, pp.638~646 (2001)
- "Improved survival with preoperative radiotherapy in resectable rectal cancer", Swedish Rectal Cancer Trial. N Engl J Med, 336, pp.980~987 (1997)
- Guillem JG, "Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer", Ann Surg, 241, pp.829~836 (2005)
- Coco C, "Long-term results after neoadjuvant radiochemotherapy for locally advanced resectable extra peritoneal rectal cancer", Dis Colon Rectum, 49, pp.311~318 (2006)
- Bosset JF, "Chemotherapy with preoperative radiotherapy in rectal cancer", N Engl J Med, 355, pp.1114~1123 (2006)
- "Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working Party", Lancet, 348, pp.1605~1610 (1996)
- Cammà C, "Preoperative radiotherapy for resectable rectal cancer : a meta-analysis", JAMA, 284, pp.1008~1015 (2000)
- Roh MS, "Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum : NSABP R-03", J Clin Oncol, 27, pp.5124~5130 (2009)
- Rullier E, "Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum", Ann Surg, 234, pp.633~640 (2001)
- Grann A, "Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma", Int J Radiat Oncol Biol Phys, 49, pp.987~995 (2001)
- Osti MF, "Neoadjuvant chemoradiation for locally advanced carcinoma of the rectum", Tumori, 90, pp.303~309 (2004)
- Gérard JP, "Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers : results of FFCD 9203", J Clin Oncol, 24, pp.4620~4625 (2006)
- Howard JH, "Prognostic factors and preoperative radiation therapy associated with sphincter preservation in patients with resectable rectal cancer", Am J Surg, 195, pp.239~243 (2008)
- Ruo L, "Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy", Ann Surg, 236, pp.75~81 (2002)
- García-Aguilar J, "A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision", Dis Colon Rectum, 46, pp.298~304 (2003)
- Hughes R, "Can pathological complete response in the primary tumour following pre-operative pelvicchemoradiotherapy for T3-T4 rectal cancer predict for sterilisation of pelvic lymph nodes, a low risk of local recurrence and the appropriateness of local excision?", Int J Colorectal Dis, 21, pp.11~17 (2006)
- Habr-Gama A., "Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy", Colorectal Dis, 8(Suppl 3), pp.21~24 (2006)
- Habr-Gama A, "Non-operative management of rectal cancer after neoadjuvant chemoradiation", Br J Surg, 96, pp.125~127 (2009)
- Sanghera P, "Chemoradiotherapy for rectal cancer : an updated analysis of factors affecting pathological response", Clin Oncol(R Coll Radiol), 20, pp.176~183 (2008)
- Kalady MF, "Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer", Ann Surg, 250, pp.582~589 (2009)