[NEJM] 절제가능한 직장암에서의 수술전 방사선요법과 Total Mesorectal Excision의 병행 의학

PREOPERATIVE RADIOTHERAPY COMBINED WITH TOTAL MESORECTAL EXCISION FOR RESECTABLE RECTAL CANCER
N Engl J Med, Vol. 345, No. 9. August 30, 2001

Background

short-term preoperative radiotherapy and total mesorectal excision : improve local control of disease in patients with resectable rectal cancer

multicenter, randomized trial : to determine whether the addition of preoperative radiotherapy increases the benefit of total mesorectal excision.

Methods

randomly assigned 1861 patients with resectable rectal cancer :
preoperative radiotherapy (5 Gy on each of five days) followed by total mesorectal excision (924 patients)
total mesorectal excision alone (937 patients)

the use of standardization and qualitycontrol measures to ensure the consistency of the radiotherapy, surgery, and pathological techniques

Results

Of the 1861 patients, 1805 were eligible

The overall rate of survival at two years (P=0.84):
82.0 percent in the group assigned to both radiotherapy and surgery
81.8 percent in the group assigned to surgery alone

Among the 1748 patients who underwent a macroscopically complete local resection :
the rate of local recurrence at two years was 5.3 percent.

The rate of local recurrence at two years (P<0.001):
2.4 percent in the radiotherapy-plus-surgery group
8.2 percent in the surgery-only group

Conclusions

Short-term preoperative radiotherapy reduces the risk of local recurrence in patients with rectal cancer who undergo a standardized total mesorectal excision

한줄요약 : 둘 다 하는 게 낫다

덧글

  • Freely 2010/08/08 04:17 #

    방사선 요법에서 궁금한게 point guide가 아닌 일정 범위에 조사하는건가요?
  • 키치너 2010/08/08 10:30 #

    네. 대부분의 경우엔 tumor mass 를 포함하는 field에 방사선을 조사합니다.
  • 위장효과 2010/08/09 09:31 #

    어느 정도는 포인트 가이드가 되긴 합니다만 결국에는 조사기가 빙빙 돌아가면서 필드를 형성하게 됩니다. 그리고 그게 더 효과를 보긴 합니다(만 부작용도 그만큼 늘어나지요.)
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