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1 국소진행된직장암의수술전화학방사선요법치료후종양반응분석 : 종양체적변화와병리조직학적병기하강과의상관관계분석 Analysis of Criteria for Tumor Response after Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Correlation between Tumor Volume Reduction and Histopathologic Downstaging Nam Kyu Kim, M.D., Hong Ryull Pyo, 1 Seung Hyuk Baik, M.D., Kang Young Lee, M.D., Seung Kook Sohn, M.D., Chang Hwan Cho, M.D., Sun Young Rha, 2 Hyun Chul Chung, 2 Department of Surgery, 2 Medical Oncology, Yonsei University College of Medicine, Seoul, 1 National Cancer Center, Proton Therapy Center, Ilsan, Korea Purpose: Preoperative chemoradiation treatment (CCRT) for locally advanced rectal cancer has been known to be safe and effective. The aim of study is to find any correlation between tumor volume reduction and histopathologic downstaging in locally advanced rectal cancer by preoperative CCRT. Methods: A total of 16 patients of rectal cancer were selected. They had been T3,4 N (+) preoperatively staged by using a transrectal ultrasonography and pelvic MRI. Radiation was given, a total of 5,040 cgy over 5 weeks, and systemic chemotherapy was also given 5 FU 450 mg/m 2 and leucovorin 20 mg/m 2 concurrently intravenously during the first and the fifth week of CCRT. Surgery was done 46 weeks after completion of CCRT. A 3D CT image was obtained with AcQsim PQ D (Philips, USA). Tumor volume was measured before and after CCRT. Results: The type of operative procedures were abdominoperineal resection 7, low anterior resection 5, coloanal anastomosis 3 and Hartmann operation 1. Volume reduction was ranged from 14.6% to 84.4%. Over a 50% tumor volume reductions were in 9 patients (56.2%). Pathologic complete remission was observed in 2 patients (12.5%), who showed 72% and 58.5% tumor volume reductions. Patients showing pt and/or pn downstaging patients (N=9) had a 55.9% tumor reductions ( %), and patients showing no pt and/or pn downstaging (N=7) had 51.8% volume reduction ( %). Conclusions: Preoeperative CCRT has been thought to be able to decrease tumor size and volume and to increase respectability. However, among our 9 patients who showed over 50% tumor volume reductions, 3 patients did not show any T and N downstaging, which is really important for long-term oncologic outcomes. J Korean Soc Coloproctol 2004;20: Key Words: Preoperative chemoradiation, Rectal cancer, Tumor volume reduction, Pathologic downstaging

김남규 외 7인 국소 진행된 직장암의 수술 전 화학방사선 요법 치료 후 종양반응 분석 299 Fig. 2. 3 Dimensional CT tumor volumetric analysis; tomur volume was 22.

Gross finding of resected specimen: there was no residual tumor and only fibrosis was found. 58.5%였는데 일부 측정된 종괴는 모두 조직학적으로 다.

1, 2). (43.7%)였다. pt와 pn 병기 하강이 관찰되지 않은 7예 4) 병리조직학적 소견 16명 중 병리학적 pt, pn 병기 하강을 보인 예는 9명 (56.2%)이었다.

4 김남규 외 7인 국소 진행된 직장암의 수술 전 화학방사선 요법 치료 후 종양반응 분석 299 Fig Dimensional CT tumor volumetric analysis; tomur volume was 22.7 cc after chemoradiation therapy. Fig. 3. Gross finding of resected specimen: there was no residual tumor and only fibrosis was found. 58.5%였는데 일부 측정된 종괴는 모두 조직학적으로 다. pn 병기만 하강한 경우가 4예(24%)였다. pt와 pn 보이지 않은 환자 7명의 종양 체적 감소율은 평균 분류 모두 병기 하강을 보이지 않은 경우가 7예 51.8% ( %)을 보였다(Table 2, Fig. 1, 2). (43.7%)였다. pt와 pn 병기 하강이 관찰되지 않은 7예 4) 병리조직학적 소견 16명 중 병리학적 pt, pn 병기 하강을 보인 예는 9명 (56.2%)이었다. 이중 병리학적 완전 관해(complete 도 종양의 체적 감소를 보였다. 각각 68%, 66.5%, 39.6%, 43.5%. 24.7%, 79%, 41.5% 등이었다(Table 2). 5) 재발 remission)가 2예(12.5%), pt와 pn 병기 모두 하강한 경 평균 추적 기간 1년 8개월 동안 3예가 재발하거나 우가 1예(6%), pt 병기만 하강한 경우는 2예(12.5%)였 병이 진행되었다. 1예는 다발성 폐전이, 1예는 다발성

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( )Jksc057.hwp 직장암환자의전직장간막절제술의 예측인자분석 : 불완전절제와절제시간에영향을미치는인자에관한연구 Analysis of Factors Affecting the Degree of Difficulty in Total Mesorectal Excision for Rectal Cancer: Investigation of the Factors Affecting Incomplete