Progress in Medical Physics (한국의학물리학회지:의학물리)

Korean Society of Medical Physics (한국의학물리학회)
권호 표지
DOI QR코드

DOI QR Code

Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer

국소 진행성 직장암의 수술전 동시 화학방사선치료와 온열치료병합시 수술후 부작용

  • Yea, Ji Woon (Department of Radiation Oncology, Yeungnam University College of Medicine)
  • 예지원 (영남대학교 의과대학 영남대학교병원 방사선종양학교실)
  • Received : 2014.04.30
  • Accepted : 2014.05.30
  • Published : 2014.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

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 evaluable for the analysis of acute and late toxicities. A total dose of 39.6 Gy or 45 Gy was delivered concurrently with one or two cycles of chemotherapy (5-fluorouracil, leucovorin). Eighty-eight patients received regional HT twice a week using an 8-MHz radiofrequency capacitive heating device. Surgery was performed 4~6 weeks after the completion of preoperative CCRT. The median age was 59 years (range, 18~83) and the median follow-up period was 61months (range, 2~191). The 5-year overall survival and complication-free survival rate of all patients was 77.4% and 73.7%, respectively. Early leakage, delayed leakage, anastomotic stricture, fistula, and small bowel obstruction occurred in 1.0%, 2.9%, 1.5%, 5.9%, and 17.1%, respectively. HT did not increase all kinds of complications. The 5-year complication-free survival rate was 71.8% in the non-HT group and 76.3% in the HT group (p=0.293). Regional HT did not increase postoperative complications in patients with locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

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.

Keywords

References

  1. McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis 10:126-32(1995) https://doi.org/10.1007/BF00298532
  2. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 264:1444-1450(1990) https://doi.org/10.1001/jama.1990.03450110090034
  3. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731-1740(2004) https://doi.org/10.1056/NEJMoa040694
  4. Horsman MR, Overgaard J. Hyperthermia: a potent enhancer of radiotherapy. Clin Oncol (R Coll Radiol) 19:418-26(2007) https://doi.org/10.1016/j.clon.2007.03.015
  5. De Haas-Kock DF, Buijsen J, Pijls-Johannesma M, et al. Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer. Cochrane Database Syst Rev 2009:CD006269
  6. Kang MK, Kim MS, Kim JH. Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy. Int J Hyperthermia 27:482-490 (2011) https://doi.org/10.3109/02656736.2011.563769
  7. Berdov BA, Menteshashvili GZ. Thermoradiotherapy of patients with locally advanced carcinoma of the rectum. Int J Hyperthermia 6:881-890(1990) https://doi.org/10.3109/02656739009140970
  8. van der Zee J, Gonzalez Gonzalez D, van Rhoon GC, van Dijk JD, van Putten WL, Hart AA. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet 355:1119-1125(2000) https://doi.org/10.1016/S0140-6736(00)02059-6
  9. Maluta S, Romano M, Dall'oglio S, et al. Regional hyperthermia added to intensified preoperative chemo-radiation in locally advanced adenocarcinoma of middle and lower rectum. Int J Hyperthermia 26:108-117(2010) https://doi.org/10.3109/02656730903333958
  10. Anscher MS, Lee C, Hurwitz H, et al. A pilot study of preoperative continuous infusion 5-fluorouracil, external microwave hyperthermia, and external beam radiotherapy for treatment of locally advanced, unresectable, or recurrent rectal cancer. Int J Radiat Oncol Biol Phys 47:719-24(2000) https://doi.org/10.1016/S0360-3016(00)00473-9
  11. Wust P, Rau B, Gellerman J, et al. Radiochemotherapy and hyperthermia in the treatment of rectal cancer. Recent Results Cancer Res 146:175-191(1998) https://doi.org/10.1007/978-3-642-71967-7_16
  12. Rau B, Wust P, Hohenberger P, et al. Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial. Ann Surg 227:380-389 (1998) https://doi.org/10.1097/00000658-199803000-00010
  13. Ceelen WP, Van Nieuwenhove Y, Fierens K. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev 2009: CD006041
  14. Schulze T, Wust P, Gellermann J, et al. Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients. Int J Hyperthermia 22:301-318(2006) https://doi.org/10.1080/02656730600665504
  15. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355-358(1998) https://doi.org/10.1046/j.1365-2168.1998.00615.x
  16. Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105-113(1997) https://doi.org/10.1016/S1072-7515(97)00018-5
  17. Yeh CY, Changchien CR, Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9-13(2005)
  18. Kim CW, Kim JH, Yu CS, et al. Complications after sphincter- saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery. Int J Radiat Oncol Biol Phys 78:156-163(2010) https://doi.org/10.1016/j.ijrobp.2009.07.1684
  19. Horie H, Kashiwagi H, Konishi F, Furuta K, Ozawa A, Kanazawa K. Improved outcome following preoperative radiochemotherapy: 40.5 Gy accelerated hyperfractionation and 5-fluorouracil suppositories for patients with carcinoma of the lower rectum. Surg Today 29:992-998(1999) https://doi.org/10.1007/s005950050634
  20. Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H. The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg 64:264-274(1993)

Cited by

  1. Selecting patients for hyperthermia combined with preoperative chemoradiotherapy for locally advanced rectal cancer vol.23, pp.2, 2014, https://doi.org/10.1007/s10147-017-1213-z