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J Korean Soc Ther Radiol Oncol > Volume 18(4); 2000 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2000;18(4): 293-299.
Efficacy of a Preoperative Concurrent Chemoradiotherapy for the Locally Advanced Unresectable Rectal Cancer
Jae Ho Cho, Jinsil Seong, Ki Chang Keum, Gwi Eon Kim, Chang Ok Suh, Jae Kyung Roh, Hyun Cheol Chung, Jin Sik Min, Nam Kyu Kim
1Department of Radiation Oncology, Yonsei University College of Medicine. Seoul, Korea.
2Department of Internal Medicine, Yonsei University College of Medicine. Seoul, Korea.
3Department of General Surgery, Yonsei University College of Medicine. Seoul, Korea.
4Yonsei Cancer Center, Yonsei University College of Medicine. Seoul, Korea.
We conducted a prospective non-randomized clinical study to evaluate the efficacy and toxicity of the preoperative concurrent chemoradiotherapy for locally advanced unresectable rectal cancer.
Between January 1995 and June 1998, 37 consecutive patients with locally unresectable advanced rectal cancer were entered into the study. With 3- or 4- fields techniuqe, a total of 45 Gy radiation was delivered on whole pelvis, followed by 5.4 Gy boost to the primary tumor in some cases. Chemotherapy was done at the first and fifth week of radiation with bolus i.v. 5-Fluorouracil (FU) 370~450 mg/m2, days 1~5, plus Leucovorin 20 mg/m2, days 1~5. Of 37 patients, 6 patients did not receive all planned treatment course (refusal in 4, disease progression in 1, metastasis to lung in 1). Surgical resection was undergone 4~6 weeks after preoperative concurrent chemoradiotherapy.
Complete resection rate with negative margins was 94% (29/31). Complete response was seen in 7 patients (23%) clinically and 2 patients (6%) pathologically. Down staging of tumor occured in 21 patients (68%). Treatment related toxicity was minimal except grade III & IV leukopenia in 2 patients, respectively.
Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer was effective in inducing down staging and complete resection rate. Treatment related toxicity was minimal. Further follow up is on-going to determine long term survival following this treatment.
Key Words: Preoperative chemoradiotherapy, Rectal cancer
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