대한대장항문학회

Purpose: Preoperative concurrent chemoradiation for locally advanced rectal cancer can<br>reduce tumor volume and can eliminate viable tumor cells at surgical margin (lateral or<br>posterior margin). It also achieve a rate of high resectability, and negative margin and also<br>have been known to be a safe treatment modality even though its fatal complication was<br>reported as 4%. The aim of this study is to analyze its efficacy and complications after<br>concurrent chemoradiation treatment for advanced rectal cancer.<br>Methods: We recruited a total thirty three patients with locally advanced rectal cancer,<br>which were staged preoperatively as T3 or T4 and multiple enlarged lymph nodes by<br>Transrectal Ultrasonography or pelvic Magnetic Resonance Image between march 1996 and<br>June, 1998. 5 Fluorouracil 450 ㎎/㎡ and leucovorin 30 ㎎ infused intravenously during the<br>first and fifth weeks of radiation therapy (4500∼5040 cGy). Surgical resection was performed<br>after four or six weeks after completing radiation therapy. To follow up tumor response,<br>digital rectal examination and transrectal ultrasonography were done every two weeks.<br>Results: Tumor level was distal (N=16, 48.4%), middle (N=9, 27.2%) and upper (N=8, 24.4%).<br>mean age was fifty two years old. Overall resectability was 91%. Types of operations were<br>abdominoperineal resection (N=10, 30.3%), Low anterior resection (N=8, 24.2), Hartmann (N=8,<br>24.2%), Posterior exenteration (N=2. 6.1%), Total pelvic exenteration (N=2, 6.1%), colostomy<br>only (N=3, 9.1%). Tumor response was Complete remission (N=3,10%), Partial response<br>(N=17, 57%), Non-response (N=10, 33%), progressive disease (N=3). Pathological status was<br>No residual tumor (N=3, 10%), T2N1 (N=5, 16.6%), T3N0 (N=6, 20%), T4N0 (N=4, 13.3%),<br>T2N1 (N=1, 3.3%), T3N1 (N=11, 36.6%). Downstaging status was as follows: from T3 to T0<br>(N=2), to T2 (N=3) and From T4 to T0 (N=1), to T2 (N=3), to T3 (N=3). Postoperative<br>morbidity was noted in 2 patients (1 case of anastomotic leakage, 1 case of wound infection).<br>Conclusions: Preoperative concurrent chemoradiation therapy for locally advanced rectal<br>cancer can be performed safely and show high tumor response and resectability.<br>