Kim Dae Yong, Jung Kyung Hae, Kim Tae Hyun, Kim Duck-Woo, Chang Hee Jin, Jeong Jun Yong, Kim Young Hoon, Son Seok-Hyun, Yun Tak, Hong Chang Won, Sohn Dae Kyung, Lim Seok-Byung, Choi Hyo Seong, Jeong Seung-Yong, Park Jae-Gahb
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):378-84. doi: 10.1016/j.ijrobp.2006.08.063. Epub 2006 Nov 9.
To describe our experience with a bolus injection of 5-fluorouracil and leucovorin (FL) vs. capecitabine in terms of radiologic and pathologic findings in preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer.
The study enrolled 278 patients scheduled for preoperative CRT using two protocols with different chemotherapeutic regimens. Pelvic radiotherapy (50.4 Gy) was delivered concurrently with FL (n = 145) or capecitabine (n = 133). Surgery was performed 6 weeks after CRT completion. Tumor responses to CRT were measured using both radiologic and pathologic examination. Magnetic resonance volumetry was performed at the initial workup and just before surgery after completion of preoperative CRT. Post-CRT pathology tests were used to determine tumor stage and regression.
Radiologic examination showed that tumor volume decreased by 68.2% +/- 20.5% in the FL group and 68.3% +/- 22.3% in the capecitabine group (p = 0.970). Postoperative pathologic T stage determination showed that downstaging occurred in 44.3% of FL and 49.9% of capecitabine patients (p = 0.571). The tumor regression grades after CRT were Grade 1 (minimal response) in 22.6% and 21.0%, Grade 2 (moderate response) in 53.2% and 50.0%, Grade 3 (near-complete response) in 12.9% and 12.9%, and Grade 4 (complete response) in 11.3% and 16.1% of the FL and capecitabine groups, respectively (p = 0.758).
In the present study, the radiologic and pathologic findings did not reveal significant differences in short-term tumor responses between preoperative FL and capecitabine CRT for locally advanced rectal cancer. Long-term results and a prospective randomized trial are needed.
根据局部晚期直肠癌术前放化疗（CRT）的影像学和病理结果，描述我们对大剂量注射5-氟尿嘧啶和亚叶酸（FL）与卡培他滨的应用经验。
该研究纳入了278例计划采用两种不同化疗方案的术前CRT患者。盆腔放疗（50.4 Gy）与FL（n = 145）或卡培他滨（n = 133）同步进行。CRT完成6周后进行手术。使用影像学和病理检查测量肿瘤对CRT的反应。在初始检查时以及术前CRT完成后手术前进行磁共振体积测量。CRT后的病理检查用于确定肿瘤分期和消退情况。
影像学检查显示，FL组肿瘤体积减少68.2%±20.5%，卡培他滨组减少68.3%±22.3%（p = 0.970）。术后病理T分期确定显示，FL组44.3%的患者和卡培他滨组49.9%的患者出现降期（p = 0.571）。CRT后的肿瘤消退分级在FL组和卡培他滨组中，1级（最小反应）分别为22.6%和21.0%，2级（中度反应）分别为53.2%和50.0%，3级（近完全反应）分别为12.9%和12.9%，4级（完全反应）分别为11.3%和16.1%（p = 0.758）。
在本研究中，影像学和病理结果显示，局部晚期直肠癌术前FL和卡培他滨CRT的短期肿瘤反应无显著差异。需要长期结果和前瞻性随机试验。
