Radiation Therapy with or without Chemotherapy and Hyperthermia for Recurrent Rectal Cancer. Efficacy and Disadvantage of Combined Therapy.:EFFICACY AND DISADVANTAGE OF COMBINED THERAPY
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47 patients (Male: Female 36: 11) with intrapelvic recurrent rectal cancer were prescribed radiation alone (17 patients), radiation and chemotherapy (18 patients) or radiation with hyperthermia (12 patients) from 1989 to 1995. There were no significant differences in patients' characteristics among these treatment groups. To discuss efficacies and disadvantages of these combined therapies, tumor response rate, pain control rate, duration of tumor control and pain control, and influence on patients' survival were evaluated.<BR>Radiation was delivered to the whole pelvis (peri-internal iliac arterial and presacral regions). Mean total dose was 45.5Gy (1.5-2 Gy/fraction). Chemotherapy consisted 5-FU (p.o. daily) in 11 cases or CDDP and ADM (once during radiation therapy) in 7cases. Hyperthermia were added 3-6times (mean 4.5times) concomitantly to the radiation.<BR>In all patients receiving more than 30Gy radiation, tumor response rate was 56.8%(PR 25/45patients). Tumor response rates were 35.3%, 43.7% and 41.7% in the radiation alone group, radiation and chemotherapy group and radiation with hyperthermia group respectively. Radiation combined chemotherapy was more effective for the tumor less than 5cm diameter than radiation alone (p<0.01). In cases receiving over 50Gy radiation, combined treatments were more effective than radiation alone (p<0.05). Pain relief was obtained in 75.9% of patients (22/29cases) and there were no difference between three treatment groups. Tumor control was significantoly prolonged in combined groups (p≤0.05). Median survival periods were 6, 10 and 7 months (N.S.) for radiation alone, radiation and chemotherapy, and radiation with hyperthermia respectively. In PR cases and for tumors under 5cm in diameter, there were no difference between three groups. In cases receiving over 50Gy radiation, survival period was prolonged in radiation with hyperthermia (p<0.05).<BR>14 patients developed acute toxicity (Leucopenia) and late complication due to bowel obstruction. The incidence of bowel complication was 27.8% for radiation and chemotherapy and 33.3% for radio-hyperthermia, while 17.6%, significantly low percentage (p<0.05), for radiation alone. Bowel obstruction may occur positively correlated with postsurgical adhesions and infections at initial surgery (p<0.001).<BR>These data suggest that combined radiation therapy with radiation, chemotherapy orh yperthermia was effective for local intrapelvic recurrence of rectal cancer especially in pain control. However, risk of bowel complication is increased by combined radiation therapy. This bowel complication is frequently observed in patients with post-surgical complications.
- 一般社団法人 日本放射線腫瘍学会の論文
一般社団法人 日本放射線腫瘍学会 | 論文
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