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국소 진행성 직장암의 수술전 동시 화학방사선치료와 온열치료병합시 수술후 부작용
Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer 원문보기

Progress in Medical Physics = 의학물리, v.25 no.2, 2014년, pp.89 - 94  

예지원 (영남대학교 의과대학 영남대학교병원 방사선종양학교실)

초록
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국소 진행성 직장암 환자에서 수술 전 항암방사선동시요법으로 치료시 추가적인 고주파 온열치료 유무가 수술 후 부작용에 미치는 영향을 분석하였다. 1996년부터 2007년 사이, 본원에서 수술 전 항암방사선동시요법과 근치적 수술을 시행한 환자 205명을 대상으로 급, 만성부작용을 분석하였다. 총 방사선치료선량은 39.6 Gy에서 45 Gy였고 1회 내지 2회의 항암약물치료(5-fluorouracil, leucovorin)를 동시에 시행하였다. 88명의 환자가 주 2회, 8-MHz 고주파 온열치료기를 이용한 국소 온열치료를 시행하였다. 외과적 수술은 수술 전 치료 완결 후 4~6주 경과하여 시행하였다. 환자군의 나이 중앙값은 59세(18세~83세)이고 추적관찰기간 중앙값은 61개월(2개월~191개월)이었다. 전체 환자에서 5년 전체생존율과 무합병증 생존율은 77.4%와 73.7%였다. 각각의 조기 누출, 지연 누출, 연결부 협착, 누공, 소장폐쇄의 발생빈도는 1.0%, 2.9%, 1.5%, 5.9%, 그리고 17.1%였다. 온열치료는 모든 종류의 부작용을 증가시키지 않았다. 온열치료를 실시하지 않은 군과 온열치료군 간의 5년 무합병증 생존율은 71.8%와 76.3%였다(p=0.293). 온열치료는 수술전 항암방사선동시요법 후 근치적 수술을 시행하는 국소 진행 직장암 환자의 수술후 부작용을 증가시키지 않는다.

Abstract AI-Helper 아이콘AI-Helper

We investigated whether regional hyperthermia (HT) increased post-surgical complications in patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT). Between 1996 and 2007, 205 patients treated with preoperative CCRT and curative surgery were evaluab...

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제안 방법

  • Chemotherapy commenced concurrently with RT, and a total of 2∼3 cycles of chemotherapy were administered before surgery. All patients received 5-fluorouracil and leucovorin; 5-fluorouracil (425 mg/m2/day) was continuously infused for 5 days during the first and last weeks of RT, and leucovorin (20 mg/kg) was infused on each day of chemotherapy. Mitomycin C (10 mg/m2) was infused on day 1 in 161 patients.
  • Categorical variables were compared with the chi-square test or Fisher’s exact test, and continuous ones with the student t-test for a comparison of the two groups.
  • Complications were evaluated through medical records, including physical examinations, colonofiberscopy and diagnostic images. Early leakage was defined as leakage that occurred within one month after surgery and delayed anastomotic leakage was defined as leakage thereafter.
  • Thus, we retrospectively analyzed the impact of HT using a capacitive type machine on postoperative complications in locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

대상 데이터

  • 8) reported the results of the phase III study, comparing RT with and without HT in locally advanced cervical, rectal and bladder cancer. A total of 358 patients were enrolled. In primary or recurrent rectal cancer patients, a total dose of 46∼50 Gy with or without a boost of 10∼24 Gy was delivered.
  • The surgeon determined the type of surgery and total mesorectal excision was routinely performed. Adjuvant chemotherapy was administered in 198 patients. The same regimen as the preoperative treatment, except mitomycin C, was delivered to 164 patients for up to 12 cycles.
  • In this study, 205 patients who were evaluable for acute and late toxicities after surgery were analyzed. Patients with a follow-up period of less than 6 months after surgery (n=12) or who had previous abdominal surgery history (n=5) or who received postoperative RT (n=13) were excluded.
  • All patients received 5-fluorouracil and leucovorin; 5-fluorouracil (425 mg/m2/day) was continuously infused for 5 days during the first and last weeks of RT, and leucovorin (20 mg/kg) was infused on each day of chemotherapy. Mitomycin C (10 mg/m2) was infused on day 1 in 161 patients.
  • 5 Gy bid) with 5-fluorouracil, given as suppositories, was given. Sixteen patients received HT using an 8-MHz capacitive type machine (Thermotron RF-8, Yamamoto Vinita, Tokyo, Japan). The mean follow-up period was 4.

이론/모형

  • The complication-free survival rate was calculated from the date of surgery. Log-rank test was used to test the significance of HT for survival. Statistical evaluations were performed using the SPSS statistics 20 software (SPSS, Chicago, IL).
  • Categorical variables were compared with the chi-square test or Fisher’s exact test, and continuous ones with the student t-test for a comparison of the two groups. The survival rate was calculated from the first day of CCRT to the date of the event using the Kaplan-Meier method. The complication-free survival rate was calculated from the date of surgery.
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참고문헌 (20)

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