直腸癌病人接受術後單獨放射線治療之治療結果及預後因子

Hsuan-Chih Hsu, 陳 鴻華, 王 重榮, Eng-Yen Huang, 張 家駱, 熊 敬業, 陳 惠君

Research output: Contribution to journalJournal Article peer-review

Abstract

     目的:分析直腸癌病人接受術後單獨放射線治療的治療結果與預後因子。 材料與方法:從1987年10月至1997年8月共95位接受根除性手術的直腸癌病人前來本科接 受術後放射線輔助治療,放射線治療乃採用10或15 MV的X-ray,每週治療五次,每次劑量 1.8至2 Gy不等,總劑量為52~60 Gy,每位病人均至少有兩年的追□。 結果:此95位病人之5年局部控制率、存活率、無遠處轉移率及無病存活率分別為49%、43%、 46%、35%。在預後因子方面,以單變數分析結果顯示期別(Ⅱ vs Ⅲ)、T之分期(T3 vs T4)、 N之分期(NO vs N1 vs N2)以及手術前病人血中CEA值(<5 ng/ml vs ≧5 ng/m|}四項不論在 局部控制率、存活率、無遠處轉移率、及無病存活率均有統計上的差異;但以多變數分析則只 有N之分期於局部控制率(p=0.0124}、存活率{p=0.0014}、無遠處轉移率(p=0.0012)、及無 病存活率《p=0.0010)四項同時有統計上的差異。 結論:N之分期{即腫瘤侵犯淋巴結數目)為接受術後放射線治療之直腸癌病人最重要的預後 因子,腫瘤侵犯淋巴結數目大於3顆者其預後較差,至於應該給予何種輔助治療才能使病人獲 得最大的助益,則有待更進一步的研究。
     Purpose: To analyze the treatment results and prognostic factors in rectal cancer patients receiving postoperative radiotherapy after radical resection. Materials and Methods: From October 1987 through August 1997, ninety-five patients with stage II or III (AJCC 1997) rectal cancer were treated with complete surgical resection and postoperative adjuvant pelvic irradiation without chemotherapy. The radiation was delivered with 10 or 15 MV X-ray given 5 days per week at 1.8 to 2 Gy per fraction. Total doses ranged from 52 to 60 Gy. All patients had at least 2 years of follow-up. Results: The 5-year local control rate (LC), overall survival rate (OS), distant metastasis-free rate (DMF) and disease-free survival rate (DFS) for the 95 patients were 49%, 43%, 46% and 35%, respectively. In univariate analysis, the stage (II vs. 111), T stage (T3 vs. T4), N stage (N0 vs. N1 vs. N2) and preoperative CEA (<5 vs. 5≧ ng/ml) were the significant prognostic factors in LC, OS, DMF and DFS. In multivariate analysis, the N stage was the only statistically significant predictor of LC (p= 0.0124), OS (p= 0.0014), DMF (p= 0.0012) and DFS (p=0.0010). Conclusion: N stage (the number of involved nodes) is the most important prognostic factor in rectal cancer patients receiving postoperative radiotherapy alone. Patients with more than 3 involved nodes had significantly poor treatment outcome. The optimal adjuvant treatment for rectal cancer is still controversial. Further investigation of various treatment modalities is needed.
Original languageChinese (Traditional)
Pages (from-to)179-186
Journal放射治療與腫瘤學
Volume6
Issue number3
StatePublished - 1999

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