Radiation Oncology, Chulolongkorn University : Preoperative Radiotherapy in Rectal Adenocarcinoma

Radiation Oncology Chulolongkorn University

Preoperative Radiotherapy in Rectal Adenocarcinoma

à»ç¹·ÕèÂÍÁÃÑº¡Ñ¹â´Â·ÑèÇä»áÅéÇÇèÒ ÇÔ¸Õ¡ÒÃÃÑ¡ÉÒ·Õèä´é¼Å´Õ·ÕèÊØ´ÊÓËÃÑºÁÐàÃç§ÅÓäÊéãËèÊèÇ¹»ÅÒÂ
(rectum) ¤×Í ¡ÒÃ·Ó¼èÒµÑ´ ÊèÇ¹ÇÔ¸Õ¡ÒÃÃÑ¡ÉÒàÊÃÔÁÍ×è¹ æ (adjuvant therapy) «Öè§ÍÒ¨¨Ðà»ç¹¡ÒÃãªéÇÔ¸Õ¡ÒÃ©ÒÂÃÑ§ÊÕ áÅÐ/ËÃ×Í¡ÒÃãËéÂÒà¤ÁÕºÓºÑ´¹Ñé¹ ÁÕ¨Ø´ÁØè§ËÁÒÂà¾×èÍÅ´ÍØºÑµÔ¡ÒÃ¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤ãËé¹éÍÂÅ§ áÅÐ à¾×èÍà¾ÔèÁÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂ ¹Í¡¨Ò¡¹ÕéÍÒ¨¨ÐÊÒÁÒÃ¶à»ÅÕèÂ¹ÇÔ¸Õ¡ÒÃ·Ó¼èÒµÑ´áºº abdomino
perineal resection «Öè§¼Å¤×Í¼Ùé»èÇÂµéÍ§¢Ñº¶èÒÂÍØ¨¨ÒÃÐ·Ò§Ë¹éÒ·éÍ§ÍÂèÒ§¶ÒÇÃ ÁÒà»ç¹¡ÒÃ·Ó¼èÒµÑ´áºº
Ê§Ç¹ËÙÃÙ´¢Í§·ÇÒÃË¹Ñ¡ (sphincter - sparing) «Öè§¨ÐÊÒÁÒÃ¶¢Ñº¶èÒÂÍØ¨¨ÒÃÐÍÍ¡·Ò§·ÇÒÃµÒÁ»¡µÔ â´ÂÇÔ¸Õ¡ÒÃÃÑ¡ÉÒáºº¹Õé ¨ÐµéÍ§¤Ó¹Ö§¶Ö§¼Å·Õèà¡Ô´¢Öé¹¨Ò¡¡ÒÃÃÑ¡ÉÒ ·Ò§´éÒ¹ÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ, ÀÒÇÐá·Ã¡«éÍ¹, ¤ÇÒÁÊÐ´Ç¡¤ÇÒÁÂÒ¡§èÒÂáÅÐ¤èÒãªé¨èÒÂ·ÕèµéÍ§ãªéã¹¡ÒÃÃÑ¡ÉÒÃèÇÁ¡Ñ¹ä»´éÇÂ
µèÍä»¹Õé¨Ð¢Í¡ÅèÒÇ¶Ö§¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ (preoperative irradiation) «Öè§à»ç¹ÍÕ¡ÇÔ¸Õ¡ÒÃË¹Öè§·ÕèãªéàÊÃÔÁ¡ÒÃÃÑ¡ÉÒã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum
ã¹¡ÒÃãËé preoperative irradiation ¹Ñé¹¨ÐÁÕ¢éÍ´ÕáÅÐ¢éÍàÊÕÂ àÁ×èÍà»ÃÕÂºà·ÕÂº¡Ñº¢éÍ´ÕáÅÐ¢éÍàÊÕÂ
¢Í§¡ÒÃãËé postoperative irradiation ´Ñ§áÊ´§ã¹µÒÃÒ§·Õè 1 áÅÐ 2 ¤×Í

µÒÃÒ§·Õè 1 Advantages and Disadvantages of Preoperative Irradiation

Advantages	Disadvantages
1. Reduction of tumor size and improved resectabiligy	1. Unnecessary for early tumors or tumors already spread to distant tissues
2. Decreased local-regional tumor recurrence	2. Delay in surgical resection
3. Control of tumor in the lymph nodes	3. May delay in wound healing
4. Decreased viability of tumor cells that may spread at the time of surgery
5. Fewer small bowel adhesions and less late small bowel injury

µÒÃÒ§·Õè 2 Advantages and Disadvantages of Postoperative Irradiation

Advantages	Disadvantages
1. Better selection of patients based on surgical pathologic findings	1. Radiosensitivity of the tumor may be less than the preoperative condition
2. Decreased local-regional tumor recurrence	2. No effect on cells that may spread at the time of surgery
3. Control of residual local-regional tumor	3. No improved resectability of locally unresectable tumors
4. Identification of high-risk areas	4. More small bowel problems because of adhesions and fixed bowel after surgery

ÁÕ¡ÒÃÈÖ¡ÉÒÇÔ¨ÑÂ·Ò§¤ÅÕ¹Ô¤à¡ÕèÂÇ¡Ñº¡ÒÃãªé Preoperative irradiation ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·Ñé§·Õèà»ç¹ non-randomized áÅÐ randomized trial ÍÂÙèÁÒ¡¾ÍÊÁ¤ÇÃ «Öè§¨Ò¡¡ÒÃÈÖ¡ÉÒÊèÇ¹ãËè¾ºÇèÒ¡ÒÃãËé preoperative irradiation ÊÒÁÒÃ¶¨ÐÅ´ÍØºÑµÔ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§âÃ¤ä»·ÕèµèÍÁ¹éÓàËÅ×Í§ã¡Åéà¤ÕÂ§ãËé¹éÍÂÅ§ ÁÕ pathologic complete response ¢Í§ÁÐàÃç§»°ÁÀÙÁÔä´é»ÃÐÁÒ³ 5%-10%
·ÕèÊÓ¤Ñ¤×ÍÅ´¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤à©¾ÒÐ·ÕèÅ§àËÅ×Í»ÃÐÁÒ³ 5%-20% áÅÐÁÕºÒ§ÃÒÂ§Ò¹¾ºÇèÒÊÒÁÒÃ¶
à¾ÔèÁÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµä´é´éÇÂ â´Â¨Ðáºè§¡ÅèÒÇÇÔ¸Õ¡ÒÃ¢Í§ preoperative irradiation ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ´Ñ§¹Õé¤×Í

Low dose Preoperative Irradiation

Moderate Dose Preoperative Irradiation

High Dose Preoperative Irradiation

High-Dose Radiation and Sphincter Preservation

Toxicity

Preoperative radiation and chemotherapy

Combined Pre and Postoperative Radiation

Conclusion

References

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Last modified on 25 October 1996