직장암의 수술전 방사선 단독치료군과 방사선-온열 병용치료군과의 임상적 및 병리학적 반응에 대한 비교 연구 (The clinical and Pathologic Response of Preoperative Radiotherapy alone and Thermoradiotherapy in Advanced and/or Marginally Resectable Rectal Cancer)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 13권 / 1호 / 135 ~ 142페이지
· 저자명 : 문창우, 김영호, 염하용, 정태식, 장희경

초록

Purpose : Authors studied to evaluate the clinical and pathologic responses of patients treated with preoperative radiotherapy alone and thermoradiotherapy for advanced and/or marginally resectable rectal cancer, retrospectively.
Materials and Methods : Eight patients (57%) were treated with preoperative radiotherapy alone (Group 1), and 6 (43%) were treated with thermoradiotherapy (Group 2) at department of Therapeutic Radiology, Kosin Medical College from Jan. 1990 to Dec. 1993. Hyperfractionated doses of 40.5-54 Gy (median : 42.75 Gy), and RF-8MHz capacitive hyperthermic (CANCERMIA) treatment with intrarectal temperature range of 39.8-43.5℃ (median : 41.9℃) with interval of 2 times/wk, 40-60 min/session, total 5-7 sessions was performed in 4 to 6 wks following radiation. Nine patients (64%) were performed by Miles' operation and 5 (36%) by anterior resection.
Results : Among 8 patients treated with preoperative radiation alone, 25% (2 patients) clinically downstaged after radiation, but 25% (2 patients) pathologically downstaged after operation, 37.5% (3 patients) upstaged. Among 6 patients treated with preoperative thermoradiotherapy, 50% (3 patients) clinically downstaged after thermoradiotherapy, but 16.7% (1 patient) pathologically downstaged after operation, 50% (3 patients) clinically downstaged after thermoradiotherapy, but 16.7% (1 patient) pathologically downstaged after operation, 50% (3 patients) upstaged. The major pathologic finding of surgical specimens was tumor necrosis increased. The average percentages of tumor necrosis out of total tumor mass determined by light microscope were 41.7% and 35% in Group 1 and Group 2, respectively. The rates of viable tumor cells determined by electromicroscope was 62.5% in Group 1 and 45% in Group 2. The rates of tumor volume reduction compared with initial tumor volume by physical examination, ultrasonography and CT was 52.1% in Group 1 and 69.4% in Group 2.
Conclusion : From this study, it is concluded that preoperative thermoradiotherapy compared with preoperative radiotherapy didn't show any additive effects in pathological downstaging and tumor necrosis increased, but might be an additive effects in reduction of total tumor volume and viable tumor cell in advanced and/or marginally resectable rectal cancer.

영어초록

Purpose : Authors studied to evaluate the clinical and pathologic responses of patients treated with preoperative radiotherapy alone and thermoradiotherapy for advanced and/or marginally resectable rectal cancer, retrospectively.
Materials and Methods : Eight patients (57%) were treated with preoperative radiotherapy alone (Group 1), and 6 (43%) were treated with thermoradiotherapy (Group 2) at department of Therapeutic Radiology, Kosin Medical College from Jan. 1990 to Dec. 1993. Hyperfractionated doses of 40.5-54 Gy (median : 42.75 Gy), and RF-8MHz capacitive hyperthermic (CANCERMIA) treatment with intrarectal temperature range of 39.8-43.5℃ (median : 41.9℃) with interval of 2 times/wk, 40-60 min/session, total 5-7 sessions was performed in 4 to 6 wks following radiation. Nine patients (64%) were performed by Miles' operation and 5 (36%) by anterior resection.
Results : Among 8 patients treated with preoperative radiation alone, 25% (2 patients) clinically downstaged after radiation, but 25% (2 patients) pathologically downstaged after operation, 37.5% (3 patients) upstaged. Among 6 patients treated with preoperative thermoradiotherapy, 50% (3 patients) clinically downstaged after thermoradiotherapy, but 16.7% (1 patient) pathologically downstaged after operation, 50% (3 patients) clinically downstaged after thermoradiotherapy, but 16.7% (1 patient) pathologically downstaged after operation, 50% (3 patients) upstaged. The major pathologic finding of surgical specimens was tumor necrosis increased. The average percentages of tumor necrosis out of total tumor mass determined by light microscope were 41.7% and 35% in Group 1 and Group 2, respectively. The rates of viable tumor cells determined by electromicroscope was 62.5% in Group 1 and 45% in Group 2. The rates of tumor volume reduction compared with initial tumor volume by physical examination, ultrasonography and CT was 52.1% in Group 1 and 69.4% in Group 2.
Conclusion : From this study, it is concluded that preoperative thermoradiotherapy compared with preoperative radiotherapy didn't show any additive effects in pathological downstaging and tumor necrosis increased, but might be an additive effects in reduction of total tumor volume and viable tumor cell in advanced and/or marginally resectable rectal cancer.

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