Preoperative radiotherapy with concomitant fluoropyrimidine-based chemotherapy for resectable locally advanced rectal cancer

Yıl 2008, Cilt: 23 Sayı: 4, 163 - 171, 01.05.2008

Beste Melek Atasoy Faysal Dane Hale Çağlar Evrim Tezcanlı Asım Cingi Ufuk Abacıoğlu Serdar Turhal Cumhur Yeğen

Öz

To investigate the treatment results and tumor and patient characteristics in patients with resectable locally advanced rectum cancer (LARC) who were treated with preoperative chemoradiation. METHODS T3/T4 rectal adenocarcinoma patients (n=50) were evaluated retrospectively. Tumors were located within 5 cm of the anal verge in 60% of patients. Twenty-four (48%) of the patients had positive lymph nodes. Pelvic radiotherapy was administered with a median dose of 45Gy in linear accelerator. Concurrent fluoropyrimidine was given orally (n=18) or intravenously (n=32). RESULTS Median follow-up was 17 months. Two-year local control, disease- free survival and overall survival were 93.6%, 90.3% and 93.3%, respectively. Sphincter-preserving surgery rate was 43% for distal tumors. Downstaging was observed in 35% with seven ypT0N0 cT4 (p=0.01), lymphovascular-perineural invasion (p=0.01) and pN+ (p=0.02) were predictive for a worse prognosis. Grade 3 toxicity was observed in 8% of patients. CONCLUSION Preoperative chemoradiotherapy demonstrated similar benefit regarding sphincter preservation with that of standard postoperative multimodality therapies in LARC patients.

Anahtar Kelimeler

Rectal Neoplasms, Neoadjuvant Therapy, Chemotherapy, Adjuvant, Adenocarcinoma, Survival, Pyrimidines, Preoperative Period, Radiotherapy

Rezeke edilebilir lokal ileri evre rektum kanserinde floroprimidin bazlı kemoterapi ile eş zamanlı ameliyat öncesi radyoterapi

Öz

AMAÇ Rezeke edilebilir lokal ileri evre rektum kanserinde ameliyat öncesi kemoradyoterapi sonrası tedavi cevapları, sağkalım süreleri, tümör ve hastaların demografik özellikleri değerlendirildi. GEREÇ VE YÖNTEM T3/T4 rektum adenokarsinomu tanılı, 50 (dağılım, 36-77 yaş) hasta incelendi. Tedavi öncesi 30 (%60) hastada tümör başlangıcı anal girimden ilk 5 cm içindeydi. Yirmi dört (%48) hastada nod pozitifti. Radyoterapi doğrusal hızlandırıcıyla konformal teknikle pelvik alana ortanca 45 Gy uygulandı. Eş zamanlı floroprimidin oral (n=18) veya intravenöz olarak (n=32) olarak verildi. BULGULAR Ortanca takip 17 ay, iki yıllık lokal kontrol, hastalıksız sağkalım ve tüm sağkalım oranları sırasıyla %93,6, %90,3 ve %93,3 idi. Distal tümörlerde sfinkter koruyucu cerrahi oranı %43, tüm hastalarda evre küçülmesi oranı %35 idi. Yedi hastada tam cevap (ypT0N0) elde edildi. kT4 hastalık (p=0,01), lenfovasküler- perinöral invazyon (p=0,01) ve pN+ (p=0,02) kötü prognoz göstergesiydi. Derece 3 yan etki oranı %8 idi. SONUÇ Ameliyat sonr ası ted av iye benzer sonuçları ve sfinkt eri kor um a şansıyla amel iyat öncesi mult im odal ite yaklaşımı, lokal ileri evre rektum kanserinde ted avi kararında iyi bir seçenek olabilir.

Anahtar Kelimeler

Kemoradyoterapi, neoadjuvan tedavi, rektum kanseri, Türk nüfusu.

Kaynakça

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