Radiation Oncology Chulolongkorn University

Postoperative Irradiation with or without Chemothe

µèÍ仹Õé¨Ð¢Í¡ÅèÒǶ֧ randomized trials ãË­è æ ·ÕèÊӤѭâ´Â¨ÐÊÃØ»¶Ö§¼Å¡ÒÃÃÑ¡ÉÒ·Ò§´éÒ¹
patterns of failure (local, distant) áÅÐÍѵÃÒ¡ÒÃÃÍ´ªÕÇÔµ (disease-free, overall survival)
A) ¡ÒÃÈÖ¡ÉҢͧ The National Surgical Adjuvant Breast and Bowel Program (NSABP)15
ä´éáºè§¼Ùé»èÇÂÍÍ¡à»ç¹ 3 ¡ÅØèÁ ¤×Í
1. ¡ÅØèÁ·Õè·Ó¼èҵѴÍÂèÒ§à´ÕÂÇ (surgery alone)
2. ¡ÅØèÁ·Õè·Ó¼èҵѴáÅéǵÒÁ´éÇ¡ÒéÒÂÃѧÊÕ·ÕèÍØé§àªÔ§¡ÃÒ¹ (postoperative pelvic irradiation)
»ÃÔÁÒ³ÃѧÊÕ 46 - 47 Gy ã¹ 25-27 fractions áÅÐ
3. ¡ÅØèÁ·Õè·Ó¼èҵѴáÅеÒÁ´éÇ¡ÒÃãËéÂÒà¤ÁպӺѴ (adjuvant chemotherapy) ¤×Í 5FU,
Me CCNU áÅÐ vincristine
¨Ò¡¼Å¡ÒÃÈÖ¡ÉÒ¹Õé ¾ºÇèÒ¡ÅØèÁ·Õèä´é adjuvant chemotherapy ÁÕ disease-free survival ·Õè´Õ¢Öé¹ àÁ×èÍà·Õº¡Ñº¡ÅØèÁ·Õè·Ó¼èҵѴÍÂèÒ§à´ÕÂÇ (P=.006) áµèäÁèä´é»ÃÐ⪹ìµèÍ¡ÒäǺ¤ØÁâä੾ÒзÕèËÃ×ÍÅ´ÍغѵԡÒâͧ¡ÒÃá¾Ãè¡ÃШÒ¢ͧâäÍÂèÒ§ÁÕ¹ÑÂÊӤѭ Êèǹ¼Å·Ò§´éÒ¹ÍѵÃÒ¡ÒÃÃÍ´ªÕÇÔµ (overall survival) ¹Ñé¹´ÙàËÁ×͹ÇèҨдբÖé¹ (marginal benefit P=.05) Êèǹ¡ÅØèÁ·Õèä´é postoperative pelvic irradiation ¹Ñé¹¾ºÇèÒÍѵÃÒ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕèŴŧ¨Ò¡ 25% àËÅ×Í 16% (P=.o6) áµèäÁèÁÕ»ÃÐ⪹ìµèÍ¡ÒÃà¾ÔèÁÍѵÃÒ
¡ÒÃÃÍ´ªÕÇÔµ
B) ¡ÒÃÈÖ¡ÉҢͧ GITSG trial 717516,17 ä´éáºè§¼Ùé»èÇÂÁÐàÃ秢ͧÅÓäÊéãË­èÊèǹ rectum ·Õèà»ç¹
resectable high risk patients (Dukes’B2, C) ÍÍ¡à»ç¹ 4 ¡ÅØèÁ ¤×Í
1. Surgery alone
2. Surgery plus postoperative irradiation (40-48 Gy)
3. Surgery plus adjuvant chemotherapy (5FU + Me CCNU) áÅÐ
4. Surgery plus postoperative irradiation (40-44 Gy)
and chemotherapy (5FU 500 mg/m2 x 3d in week
l + 5 of radiation and followed by 5FU + Me CCNU)
¨Ò¡¡ÒÃÈÖ¡ÉÒ¹Õé ¾ºÇèÒ¡ÅØèÁ·Õèä´éÃѺ¡ÒÃÃÑ¡ÉÒàÊÃÔÁ´éÇ¡ÒéÒÂÃѧÊÕ, ¡ÒÃãËéÂÒà¤ÁպӺѴ ËÃ×Íä´éÃѺ·Ñé§ 2 ÍÂèÒ§ ·Ø¡¡ÅØèÁ¨ÐÁÕ disease-free survival ´Õ¡ÇèÒ¡ÅØèÁ·Õè·Ó¼èҵѴÍÂèÒ§à´ÕÂÇ áµèÁÕà¾Õ§¡ÅØèÁ·Õèä´éÃѺ·Ñ駡ÒéÒÂÃѧÊÕáÅÐà¤ÁպӺѴà·èÒ¹Ñé¹·Õèä´é »ÃÐ⪹ìÍÂèÒ§ÁÕ¹ÑÂÊӤѭ·Ò§Ê¶ÔµÔàÁ×èÍà»ÃÕºà·Õº¡Ñº¡ÅØèÁ·Õè·Ó¼èҵѴÍÂèÒ§à´ÕÂÇ ¤×ÍÁÕ»ÃÐ⪹ì·Ñé§ disease-free áÅÐ overall survival (P=.009 áÅÐ .005) àªè¹à´ÕÂǡѹ¡Ñº¡ÒÃÈÖ¡ÉҢͧ NSABP ÍغѵԡÒáÒáÓàÃÔº¢Í§âä੾ÒзÕèŴŧ㹡ÅØèÁ·Õèä´éÃѺ¡ÒéÒÂÃѧÊÕ ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕèà¡Ô´¢Öé¹¹éÍ·ÕèÊØ´à¾Õ§ 11% 㹡ÅØèÁ·Õèä´é combined postoperative chemotherapy áÅÐ radiation Êèǹ㹡ÅØèÁ·Õèä´é adjuvant chemotherapy ÍÂèÒ§à´ÕÂÇ â´ÂäÁèä´é©ÒÂÃѧÊÕÁÕ¡ÒáÓàÃÔº¢Í§âä
੾ÒзÕèÊÙ§·ÕèÊØ´¶Ö§ 27% ÊÓËÃѺÍغѵԡÒâͧ Distan failures ¾ºÇèÒŴŧ㹡ÅØèÁ·Õèä´éÃѺ chemotherapy ± radiation àÁ×èÍà·Õº¡Ñº¡ÅØèÁ·ÕèäÁèä´é chemotherapy
C) ¡ÒÃÈÖ¡ÉҢͧ The Mayo / NCCTG randomized trial (79-47-51)18 ¡ÒÃÈÖ¡ÉÒ¹Õéáºè§¼Ùé»èÇ·Õèà»ç¹ resected high-risk patients à»ç¹ 2 ¡ÅØèÁ ¤×Í
1. ¡ÅØèÁ·Õèãªé postoperative irradiation â´ÂãËé»ÃÔÁÒ³ÃѧÊÕ 50.4 Gy/28 Fx ã¹ÃÐÂÐàÇÅÒ
5 1/2 ÊÑ»´ÒËì (1.8 Gy/Fx)
2. ¡ÅØèÁ·ÕèãËé adjuvant chemotherapy (5FU + Me CCNU) áÅеÒÁ´éÇ¡ÒéÒÂÃѧÊÕ (àªè¹à´ÕÂǡѺ¡ÅØèÁ·Õè 1) ¾ÃéÍÁ¡Ñº¡ÒÃãËé 5FU 500 mg/m2 x 3d wk l + 5 ¢Í§¡ÒéÒÂÃѧÊÕ áÅÐãËé 5 FU + Me CCNU µèÍËÅѧ¨Ò¡©ÒÂÃѧÊդúáÅéÇ
¨Ò¡¡ÒÃÈÖ¡ÉÒ¹Õé ¾ºÇèÒ¡ÅØèÁ·Õèä´éÃѺ·Ñé§ chemotherapy áÅÐ radiation ¨ÐÁÕ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕèáÅСÒÃá¾Ãè¡ÃШÒ¢ͧâäŴŧÍÂèÒ§ÁÕ¹ÑÂÊӤѭ·Ò§Ê¶ÔµÔ â´ÂÍѵÃÒ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕèà¡Ô´¢Öé¹à¾Õ§ 13.5% áÅÐ 25% 㹡ÅØèÁ·Õè©ÒÂÃѧÊÕÍÂèÒ§à´ÕÂÇ (P=.04) Êèǹ distant failures ¡çŴŧ¨Ò¡ 46% àËÅ×Í 29% (P=.0l) ÊÓËÃѺ disease free áÅÐ overall survival ¡çà¾ÔèÁ¢Öé¹ã¹¡ÅØèÁ·ÕèãËé·Ñé§ chemotherapy/ radiation àÁ×èÍà»ÃÕºà·Õº¡Ñº¡ÅØèÁ·ÕèãËé¡ÒéÒÂÃѧÊÕÍÂèÒ§à´ÕÂÇ (59% VS 37%, P=.002; 58% VS 48%, P=.025)
¡ÒÃÈÖ¡ÉÒã¹ÃÐÂжѴÁҢͧ GITSG 7180 áÅÐ NCCTG 86-47-5l19 áÊ´§ãËéàËç¹ÇèÒ Methyl CCNU äÁèä´éÁÕ»ÃÐ⪹ìà¾ÔèÁàµÔÁàÁ×èÍãªéÃèÇÁ¡Ñº irradiation plus 5FU20 ¹Í¡¨Ò¡¹ÕéÂѧ¾ºÇèÒ Methyl CCNU ¨Ðà¾ÔèÁÍغѵԡÒáÒÃà¡Ô´ÁÐàÃç§àÁç´àÅ×Í´¢ÒÇ (Leukemia) ´éÇÂ
áÁéÇèÒ¨Ò¡¡ÒÃÈÖ¡ÉÒµèÒ§æ àËÅèÒ¹Õé ¾ºÇèÒ¡ÒÃãËé adjuvant treatment ´éÇ radiation áÅÐ
chemotherapy ÊÒÁÒöŴÍغѵԡÒáÓàÃÔº¢Í§âä੾ÒзÕè ŧä´é»ÃÐÁÒ³¤ÃÖè§Ë¹Öè§àÁ×èÍà»ÃÕºà·Õº¡Ñº
¡Ò÷ӼèҵѴÍÂèÒ§à´ÕÂÇ¡çµÒÁ ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕè ¡çÂѧà¡Ô´¢Öé¹ l0-20%12-14 ÊÔ觷ÕèàÃÒ¤Ò´ËÇѧ¤×;ÂÒÂÒÁÅ´ÍѵÃÒ¡ÒáÓàÃÔº¢Í§âä੾ÒзÕè ãËéà¡Ô´¢Öé¹äÁèà¡Ô¹ 5% â´Â¡ÒÃÈÖ¡ÉÒã¹ÃÐÂеèÍä» à»ç¹¡ÒÃà»ÃÕºà·ÕºÇÔ¸Õ¡ÒÃãËéÂÒ 5FU Ẻ Bolus VS continuous infusion, bolus 5FU alone or bolus 5FU plus low dose leucovorin ÃèÇÁ¡Ñº¡ÒéÒÂÃѧÊÕ à»ç¹µé¹

Last modified on 25 October 1996