Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Salvage Treatment for Locally Recurrent Rectal Cancer

국소적으로 재발한 직장암 구제 치료 결과

  • Noh Jae-Myoung (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn Yong-Chan (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoon Sang-Min (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh Seung-Jae (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim Do-Hoon (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chun Ho-Kyung (Departments of Surgery and Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee Woo-Yong (Departments of Surgery and Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yun Seong-Hyeon (Departments of Surgery and Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang Won-Ki (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park Young-Suk (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park Joon-Oh (Departments of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park Won (Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 노재명 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 안용찬 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 윤상민 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 허승재 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 임도훈 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 전호경 (성균관대학교 의과대학 삼성서울병원 외과) ;
  • 이우용 (성균관대학교 의과대학 삼성서울병원 외과) ;
  • 윤성현 (성균관대학교 의과대학 삼성서울병원 외과) ;
  • 강원기 (성균관대학교 의과대학 삼성서울병원 혈액종양내과) ;
  • 박영석 (성균관대학교 의과대학 삼성서울병원 혈액종양내과) ;
  • 박준오 (성균관대학교 의과대학 삼성서울병원 혈액종양내과) ;
  • 박원 (성균관대학교 의과대학 삼성서울병원 방사선종양학과)
  • Published : 2006.06.01
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Abstract

Purpose: To evaluate the treatment outcome according to the salvage treatment modalities and identify the prognostic factors influencing the survival. Materials and Methods: Forty-five patients with locally recurrent rectal cancer treated between 1994 to 2003 were reviewed retrospectively. Median time from initial surgery to loal recurrence was 16months. Of the patients, 25 (56%) recurred at presacral and perirectal space. Among the 18 (40%) patients who received salvage surgery, 14 patients were treated with postoperative chemoradiotherapy. Among 27 (60%) patients who didn't receive salvage surgery, 16 were treated with chemoradiotherapy and 11 were treated with radiotherapy alone. Radiotherapy was given with total dose ranging from 37.5 to 64.8 Gy. Results: Five-year locoregional progression-free survival rate and overall survival rate of all patents were 49.5% and 34.3%, respectively. The 5-year locoregional progression-free survival rate and overall survival rate of patients undergoing salvage surgery were 77.0% and 52.1% compared with 36.0% and 37.9% f3r patients treated with chemoradiotherapy and 0% and 0% for patients treated with radiotherapy alone, respectively. The 5-year locoregional progression free survival and overall survival of patients who recurred earlier than 24 months were higher (67.5% and 59.1%) than the other patients (39.5% and 24.9%). Among the 27 patients who didn't receive salvage surgery, there was no significant difference for locoregional progression free survival and overall survival between re-irradiated patients and radiation-naive patients. Conclusion: Surgical resection is preferred to treatment for locally recurrent rectal cancer. If salvage surgery is not possible, chemoradiotherapy may achieve higher locoregional progression free survival and overall survival than radiotherapy alone.

목적: 국소적으로 재발한 직장암에 대한 구제 치료방법에 따른 결과 및 치료성적을 알아보고, 생존율에 영향을 주는 예후인자를 알아보고자 하였다. 대상 및 방법: 1994년 10월부터 2003년 12월까지 국소적으로 재발한 직장암으로 삼성서울병원에서 구제 치료로 방사선 치료 단독 혹은 수술이나 항암화학요법이 병행된 45명의 환자를 후향적으로 분석하였다. 환자 연령은 29-72세(중앙값 59세)였고, 남녀 각각 28명(52%), 17명(38%)이었다. 최초 치료 후 무병생존기간은 3-73개월(중앙값 16 개월)이었고, 재발부위는 천골 전방 및 직장 주위 25명(56%), 문합 부위 15명(33%), 회음부 3명(7%), 골반벽 2명(4%)이었다. 구제치료로 수술이 시행된 18명(40%)의 환자 중, 14명은 수술 후 방사선치료와 항암화학요법 병행 치료를 받았으며, 나머지 4명은 방사선 치료만을 받았다. 수술을 받지 않은 27명(60%)의 환자 중, 16명은 방사선치료와 항암화학요법을 병행하였고, 11명은 방사선치료만 시행하였다. 방사선치료는 37.5-64.8 Gy (중앙값 51 Gy)를 시행하였으며, 1회 조사선량은 1.8-3Gy였다. 이전에 방사선치료를 받은 적이 있는 13명의 환자는 37.5-60Gy (중앙값 50 Gy), 방사선치료를 받은 적이 없는 32명의 환자는 44-64.8Gy (중앙값 51 Gy)를 시행하였다. 결과: 추적관찰기간은 구제 치료의 시작시점으로부터 2-104개월(중앙값 31개월)이었다. 5년 국소제어율과 전체생존율은 각각 49.5%와 34.3%였다. 수술을 받은 환자의 5년 국소제어율이 77.0%로 나타났으며, 항암화학요법 및 방사선 병행 치료 환자에서는 35.0%, 방사선 단독 치료 환자에서는 0%였다(p=0.0009). 5년 전체생존율은 수술 받은 환자에서 52.1%, 항암화학요법 및 방사선 병행 치료 환자에서 37.9%, 방사선 단독 치료 환자에서 0%로 나타났다 (p=0.0016). 최초 치료 후 재발까지 기간이 24개월 미만과 이후임에 따라 5년 국소제어율이 각각 57.5% 및 39.5%였으며(p=0.0482), 5년 전체생존율은 59.1% 및 24.9%였다(p=0.0584). 수술을 받지 않은 환자 중 이전에 방사선치료를 시행 받은 적이 있는 12명과 나머지 15명의 국소제어율과 전체생존율에 유의한 차이는 없었다(p=0.5214, 0.7505). 결론: 국소적으로 재발한 직장암의 구제 치료시 가능한 한 구제수술을 시행하는 것이 좋겠고, 방사선치료 단독보다는 항암화학요법을 병행하는 것이 국소제어율 및 생존율을 높일 수 있었다.

Keywords

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