演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

局所進行直腸癌に対する化学放射線療法

演題番号 : OSY15-3

[筆頭演者]
小口 正彦:1 
[共同演者]
室伏 景子:1、田口 千藏:1、吉岡 靖生:1、角 美奈子:1、上野 雅資:2、福長 洋介:2、長山 聡:2、秋吉 高志:2、小西 毅:2、藤本 佳也:2、山口 研成:2、篠崎 英司:2、末永 光邦:2、松阪 諭:2

1:公益財団法人がん研究会有明病院・放射線治療部、2:公益財団法人がん研究会有明病院・消化器センター

 

Management of adenocarcinomas in the lower rectum challenges in terms of local tumor control and preservation of the anal sphincter. For patients with large invasive tumors, preoperative concurrent chemo-radiotherapy (CCRT) or short-course of radiotherapy (RT) have been utilized to promote tumor regression. The definitive indication for preoperative CCRT is the presence of a T3 or T4 tumor. The best regimen for preoperative treatment has not been established. We have been conducting series of in-house studies of CCRT using fluoropyrimidine (5-FU, 5'DFUR, TS-1…etc.) and short-course RT. Since 2005 to 2016, 870 patients with advanced rectal cancer were treated with pre/post-operative or palliative RT. 670 patients locally advanced lower rectal cancer were treated with preoperative RT or CCRT. Among them, short-course of RT, long-course of RT and long-course of CCRT were applied for 112 patients, 8 patients and 550 patients respectively. Only 8 patients were treated with postoperative RT, and 12 patients with local recurrence were treated with RT with/without chemotherapy. At our institutions, we generally treat patients with the 3-field technique using 3-dimensional conformal radiotherapy (3D-CRT). The use of lateral fields permits sparing of a portion of the bladder and some anteriorly placed small bowel. Also, majority of patients have been treated in the prone position with specially designed belly board, in order to reduce irradiated volume of un-involved small intestine. For 112 patients treated with short-course of RT, pelvic irradiation to 25 Gy in 5 fractions was given. For 550 patients treated with long-course of CCRT, pelvic irradiation to 50.4 Gy in 28 fractions was given. Patients were treated at 1.8 Gy per day, 5 fractions per week. The 34 patients were registered in the JACCRO study and 64 patients were registered in the IMPACT study. The outcome of the in-house studies will be presented.

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