Radiation Oncology, Chulolongkorn University : High Dose Preoperative Irradiation

Radiation Oncology Chulolongkorn University

High Dose Preoperative Irradiation

¤×Í¡ÒÃ©ÒÂÃÑ§ÊÕã¹¢¹Ò´·Õè > 4,000 cGy ¢Öé¹ä» «Öè§¢¹Ò´¢Í§ÃÑ§ÊÕ·ÕèãËéáµèÅÐ¤ÃÑé§¨ÐÍÂÙèÃÐËÇèÒ§
180-200 cGy ã¹·Ò§·ÄÉ¯ÕáÅéÇ »ÃÔÁÒ³ÃÑ§ÊÕ¢¹Ò´¹Õé¨ÐÊÒÁÒÃ¶·ÓãËé¡éÍ¹à¹×éÍÁÐàÃç§ÁÕ¢¹Ò´àÅç¡Å§ áÅÐ¡Ó¨Ñ´ microscopic cancer cell ·ÕèÍÂÙèã¹µèÍÁ¹éÓàËÅ×Í§ µÅÍ´¨¹à«ÅÅìÁÐàÃç§¢¹Ò´àÅç¡ æ ·ÕèÍÂÙèÅÖ¡ã¹ÍØé§àªÔ§¡ÃÒ¹·Õè¡ÒÃ·Ó¼èÒµÑ´à¢éÒäÁè¶Ö§ ÍÑ¹à»ç¹¤ÇÒÁËÇÑ§ãËÁèÇèÒ¨Ð·ÓãËéÁÕ¡ÒÃ¤Çº¤ØÁâÃ¤à©¾ÒÐ·ÕèáÅÐÍÑµÃÒ
¡ÒÃÃÍ´ªÕÇÔµ ·Õè´Õ¢Öé¹¡ÇèÒ¡ÒÃãªé low dose ËÃ×Í moderate dose preoperative irradiation
ÁÕÃÒÂ§Ò¹¡ÒÃÈÖ¡ÉÒ·Ñé§·Õèà»ç¹ nonrandomized and randomized studies (µÒÃÒ§·Õè 5) ·ÕèáÊ´§¶Ö§»ÃÐâÂª¹ì¢Í§¡ÒÃãªé high dose preoperative radiation â´Âà©¾ÒÐã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum
·Õèà»ç¹ "unfavorable" cancers ¤×Í¡ÅØèÁ·ÕèÁÕ¡ÒÃÅØ¡ÅÒÁ¢Í§ÁÐàÃç§ÍÍ¡¹Í¡¼¹Ñ§¢Í§ÅÓäÊé ÁÐàÃç§à¡ÒÐµÔ´¡Ñº
ÍÇÑÂÇÐ¢éÒ§à¤ÕÂ§áÅÐ/ËÃ×ÍÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§ÁÐàÃç§à¢éÒÊÙèµèÍÁ¹éÓàËÅ×Í§ (µÒÃÒ§·Õè 6) àªè¹ ¡ÒÃÈÖ¡ÉÒ¢Í§ Stevens áÅÐ Colleagues11 ·Õè The University of Oregon ¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·Õèà»ç¹¡ÅØèÁ unfavorable â´Â¡ÒÃ©ÒÂÃÑ§ÊÕ¢¹Ò´ 5,000-6,000 cGy ã¹ÃÐÂÐàÇÅÒ 5-8 ÊÑ»´ÒËì áÅéÇµÒÁ´éÇÂ¡ÒÃ·Ó¼èÒµÑ´ËÅÑ§¨Ò¡©ÒÂÃÑ§ÊÕáÅéÇ 4-7 ÊÑ»´ÒËì ¾ºÇèÒÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµËÅÑ§¡ÒÃÃÑ¡ÉÒ·Õè 5 »Õ à·èÒ¡Ñº 53% àÁ×èÍà·ÕÂº¡Ñº 38% ã¹¡ÅØèÁ·Õè·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ ËÃ×Í¨Ò¡¡ÒÃÃÒÂ§Ò¹¢Í§ Mendenhall12 et al ·Õè The University of Florida â´Â¡ÒÃãªé preoperative irradiation ´éÇÂ»ÃÔÁÒ³ÃÑ§ÊÕ¢¹Ò´ 4,500 cGy ã¹ÃÐÂÐàÇÅÒ 5 ÊÑ»´ÒËì (l80 cGy/fraction) ¾ºÇèÒäÁèÁÕà«ÅÅìÁÐàÃç§ËÅ§àËÅ×ÍÍÂÙèàÅÂã¹à¹×éÍàÂ×èÍ·Õè·Ó¼èÒµÑ´ÍÍ¡ÁÒ¶Ö§ 11% áÅÐÍØºÑµÔ¡ÒÃ¢Í§¡ÒÃÅØ¡ÅÒÁ¢Í§ÁÐàÃç§ä»·ÕèµèÍÁ¹éÓàËÅ×Í§ (positive pelvic lymph node) ¡çÅ´Å§¤ÃÖè§Ë¹Öè§ (l9% VS 38%) àÁ×èÍà·ÕÂº¡Ñº¡ÅØèÁ·Õè·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ ¹Í¡¨Ò¡¹Õé ÍØºÑµÔ¡ÒÃ¢Í§¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤à©¾ÒÐ·ÕèáÅÐÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ à·èÒ¡Ñº 8% VS 29% (P=0.0l5) áÅÐ 71% VS 41% (P=0.008) àÁ×èÍà·ÕÂº¡Ñº¡ÒÃ·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇµÒÁÅÓ´Ñº áÅÐ·ÕèÊÓ¤ÑäÁè¾ºÇèÒÁÕÀÒÇÐá·Ã¡«éÍ¹ª¹Ô´à©ÕÂº¾ÅÑ¹ ã¹¼Ùé»èÇÂ·Õèä´éÃÑº¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´
¨Ò¡¡ÒÃÈÖ¡ÉÒµèÒ§ æ àËÅèÒ¹Õé à»ç¹·Õè»ÃÒ¡¯á¹èªÑ´áÅéÇÇèÒ»ÃÐâÂª¹ì¢Í§¡ÒÃãªé High dose preoperative radiation ¡ç¤×Í¡ÒÃÅ´ÍØºÑµÔ¡ÒÃ¢Í§¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤ã¹ÍØé§à ªÔ§¡ÃÒ¹ áÅÐÍÒ¨¨ÐÁÕ¼ÅµèÍ¡ÒÃà¾ÔèÁÍÑµÃÒ¡ÒÃÁÕªÕÇÔµÃÍ´¢Í§¼Ùé»èÇÂ â´Âà©¾ÒÐÍÂèÒ§ÂÔè§ã¹¡ÅØèÁ¼Ùé»èÇÂ·Õèà»ç¹ fixed rectal cancer áÅÐ distal rectal cancer

µÒÃÒ§·Õè 5 Results of High-Dose Preoperative Radiation in Rectal cancer

Study	Dose(Gy)	Local recur, RT(%)	Local recur, Surgery(%)	5-yr survival, RT(%)	5-yr survival, Surgery(%)
Mendenhall(12)	45	8	29	71	41
Fortier(14)	45	16	40	52	48
Stevens et al(11)	50-60	0	18	53	38
Kodner et al(15)	45	2	24	86	-
Mohiuddin et al(16)	45-60	15	36	72	-
Kligerman(13)	45	-	-	41	25

µÒÃÒ§·Õè 6 Clinical Evaluation of Cancer of the Rectum

	Favorable	Unfavorable
Tumor size	<4cm	>= 4cm
Stage		>= B2
Fixation	Mobile	Fixed
Ulceration	Absent	Present
Lymph nodes	Absent	Present
Histology	Differentiated	Undifferentiated

Randomized study ·ÕèÃÒÂ§Ò¹â´Â Kligerman et al13 «Öè§à»ÃÕÂºà·ÕÂº¡ÒÃãËé¡ÒÃ©ÒÂÃÑ§ÊÕ ¢¹Ò´ 4,500 cGy ã¹ÃÐÂÐàÇÅÒ 5 ÊÑ»´ÒËì ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ ¡Ñº¡ÅØèÁ·Õè·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ ¾ºÇèÒ¡ÅØèÁ·Õèä´éÃÑº¡ÒÃ©ÒÂÃÑ§ÊÕ ¨ÐÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ 41% à·ÕÂº¡Ñº 25% ã¹¡ÅØèÁ·Õè·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ

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Last modified on 25 October 1996