Radiation Oncology Chulolongkorn University

Postoperative Adjuvant Irradiation for Rectal

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¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãË­èÊèǹ»ÅÒ (rectum) áÁéÇèÒ¨Ò¡¡Ò÷ӼèҵѴáÅéÇ ¾ºÇèÒÊÒÁÒöµÑ´àÍÒ
¡é͹ÁÐàÃç§ÍÍ¡ä»ä´é·Ñé§ËÁ´ (complete resection) ¡çµÒÁ Âѧ¾ºÇèÒÁÕ¼Ùé»èÇ¡ÅØèÁ˹Öè§ÁÕ¡ÒáÓàÃÔº¢Í§âä
੾ÒзÕèáÅÐÁÕ¡ÒÃá¾Ãè¡ÃШÒ¢ͧâää»ÂѧÍÇÑÂÇеèÒ§ æ ·ÓãËéâÍ¡ÒÊÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂÅ´¹éÍÂŧ
ËÒ¡ÃÑ¡ÉÒ´éÇÂÇÔ¸Õ¡Ò÷ӼèҵѴà¾Õ§ÍÂèÒ§à´ÕÂÇ ¼Ùé»èÇÂ㹡ÅØèÁ·Õè¶×ÍÇèÒÁÕÍѵÃÒàÊÕè§ÊÙ§ (high risk group)
㹡ÒáÓàÃÔº¢Í§âä ¤×Í ¡ÅØèÁ·ÕèÁÕÁÐàÃ移°ÁÀÙÁÔÅØ¡ÅÒÁÍÍ¡Áҹ͡¼¹Ñ§¢Í§ÅÓäÊéãË­è ËÃ×ÍÁÕ¡ÒÃá¾Ãè
¡ÃШÒ¢ͧÁÐàÃç§ÁÒ·ÕèµèÍÁ¹éÓàËÅ×ͧ ËÃ×ÍÁÕ·Ñé§ 2 ¡Ã³ÕÃèÇÁ¡Ñ¹ (Astler-Coller B2 áÅÐ C2 ËÃ×Í Modified Astler-Coller B2-3, C1-3 ËÃ×͵ÒÁ UICC T3 T4 N0 áÅÐ T1-4, N1-3) ´Ñ§¹Ñ鹡ÒÃÃÑ¡ÉÒ¼Ùé»èÇÂ
¡ÅØèÁ«Öè§ÁÕÍѵÃÒàÊÕè§ÊÙ§ (resectable high risk cancer) ¹Õé ¨Ö§¨Óà»ç¹µéͧŴÍغѵԡÒâͧ¡ÒáÓàÃÔº¢Í§âä
੾ÒзÕèáÅСÒÃá¾Ãè¡ÃШÒ¢ͧâäŧ à¾×èÍãËéÁÕÍѵÃÒÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂà¾ÔèÁ¢Öé¹
ã¹»Õ ¤.È. 1990 ʶҺѹÊØ¢ÀÒ¾áË觪ҵԢͧ»ÃÐà·ÈÊËÃÑ°ÍàÁÃÔ¡Òä´é»ÃЪØÁà¡ÕèÂǡѺ¡ÒÃÃÑ¡ÉÒàÊÃÔÁ (adjuvant treatment) ã¹¼Ùé»èÇ·Õèà»ç¹ÁÐàÃ秢ͧÅÓäÊéãË­è 1 â´Âà¹é¹¶Ö§¡ÒÃÃÑ¡ÉÒàÊÃÔÁã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãË­èÊèǹ rectum «Ö觨еéͧ¾Ô¨ÒóһÃÐàÁÔ¹¼Å¢Í§¡ÒÃÃÑ¡ÉÒ 3 ´éÒ¹ ¤×Í
1. ÍغѵԡÒâͧ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕè (Local or Pelvic recurrence)
2. ÍѵÃÒ¡ÒûÅÍ´âä (disease free survival)
3. ÍѵÃÒ¡ÒÃÃÍ´ªÕÇÔµ (overall survival)
¨ÐàËç¹ÇèÒ¡ÒÃà¹é¹¶Ö§ÍغѵԡÒâͧ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕè¹Ñé¹ µÑé§ÍÂÙ躹à˵ؼŷÕèÇèÒ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕè¡èÍãËéà¡Ô´¤ÇÒÁÃÙéÊÖ¡·Õè¼Ô´»¡µÔ 2(morbidity) áÅÐÂÒ¡µèÍ¡Ò÷ӡÒÃÃÑ¡ÉÒ à¾×èÍËÇѧ¼ÅãËé
ËÒ¢Ҵ3 «Ö觼Ùé»èÇÂÁÑ¡¨ÐÁÕªÕÇÔµÍÂÙèä´é»ÃÐÁÒ³ 6-12 à´×͹ áÅÐÍÂÙè´éǤÇÒÁ·Ø¡¢ì·ÃÁÒ¹ËÅѧ¨Ò¡ÁÕâä¡ÓàÃÔºã¹ÍØé§àªÔ§¡ÃÒ¹ Êèǹ¡ÒÃá¾Ãè¡ÃШÒ¢ͧâä (distant metastasis) ¨Ð¡èÍãËéà¡Ô´ morbidity 㹪èǧÃÐÂÐàÇÅÒ·ÕèÊÑ鹡ÇèÒàÁ×èÍà·Õº¡Ñº local recurrence2

Patterns of failure

Adjuvant Postoperative Irradiation

Postoperative Irradiation with or without Chemothe

Complications and Therapeutic Ratio

Conclusion

Future Possibilities

References

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Last modified on 25 October 1996