Radiation Oncology, Chulolongkorn University : Preoperative radiation and chemotherapy

Radiation Oncology Chulolongkorn University

Preoperative radiation and chemotherapy

à¹×èÍ§¨Ò¡¼Å¡ÒÃÈÖ¡ÉÒ¢Í§¡ÒÃãªé adjuvant postoperative radiation ÃèÇÁ¡Ñº chemotherapy ã¹¼Ùé»èÇÂÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·Õèà»ç¹ randomized trial25,26 áÊ´§ãËéàËç¹ÇèÒÊÒÁÒÃ¶Å´ÍÑµÃÒ¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤à©¾ÒÐ·ÕèÅ§ áÅÐÂÑ§à¾ÔèÁÍÑµÃÒ¡ÒÃ»ÅÍ´âÃ¤áÅÐÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂä´é ·ÓãËéÁÕ¡ÒÃÈÖ¡ÉÒ¡ÒÃãªé preoperative radiation ÃèÇÁ¡Ñº chemotherapy ·Ñé§¹Õéâ´ÂÍÒÈÑÂ¢éÍ´Õ¢Í§¡ÒÃãËé preoperative radiation ·ÕèàË¹×Í¡ÇèÒ postoperative radiation ´Ñ§·Õèà¤Â¡ÅèÒÇÁÒáÅéÇ¢éÒ§µé¹ ¤×Í¡ÒÃãªé preoperative radiation ¨ÐªèÇÂÅ´¡ÒÃÅØ¡ÅÒÁ¢Í§âÃ¤ã¹¢³Ð·Ó¡ÒÃ¼èÒµÑ´Å§ä´é áÅÐà«ÅÅìÁÐàÃç§¨ÐÁÕ¤ÇÒÁäÇµèÍÃÑ§ÊÕ·Õè´Õ¡ÇèÒ à¹×èÍ§¨Ò¡ÁÕàÅ×Í´áÅÐÍêÍ¡«Ôà¨¹ÁÒàÅÕéÂ§ÁÒ¡¡ÇèÒ à¾ÔèÁâÍ¡ÒÊã¹¡ÒÃ·Ó¼èÒµÑ´ä´é§èÒÂ¢Öé¹ ËÃ×Íà»ÅÕèÂ¹ÊÀÒ¾
¨Ò¡·Õè¼èÒµÑ´äÁèä´é ·ÓãËéÊÒÁÒÃ¶¼èÒµÑ´ÍÍ¡ä´é ¹Í¡¨Ò¡¹ÕéÍÒ¨¨Ð·Ó¡ÒÃ¼èÒµÑ´áºº sphincter sparing ãËé¡Ñº¼Ùé»èÇÂ ·ÓãËé¼Ùé»èÇÂÃÒÂ¹Ñé¹ æ ÁÕ¤Ø³ÀÒ¾ªÕÇÔµ·ÕèÊÁºÙÃ³ì¢Öé¹ áÅÐ¾ºÇèÒ¨ÐÁÕÀÒÇÐá·Ã¡«éÍ¹µèÍÅÓäÊéàÅç¡Å´Å§ à¹×èÍ§¨Ò¡äÁèÁÕÅÓäÊéàÅç¡ÁÒµÔ´ÍÂÙèã¹ÍØé§àªÔ§¡ÃÒ¹¢³Ð©ÒÂÃÑ§ÊÕ áÅÐ»ÃÐ¡ÒÃÊÓ¤Ñ¤×Í ¾ºÇèÒÂÒà¤ÁÕºÓºÑ´â´Âà©¾ÒÐ 5FU ÊÒÁÒÃ¶à¾ÔèÁ»ÃÐÊÔ·¸ÔÀÒ¾¢Í§ÃÑ§ÊÕã¹¡ÒÃ·ÓÅÒÂà«ÅÅìÁÐàÃç§27,28 ¨Ö§·ÓãËéÁÕ¡ÒÃ¹ÓÇÔ¸Õ¡ÒÃ¹ÕéÁÒãªé áµèà¹×èÍ§¨Ò¡¡ÒÃÈÖ¡ÉÒ¹Õéà¾ÔèÁàÃÔèÁã¹ÃÐÂÐäÁè¡Õè»ÕËÅÑ§¹ÕéàÍ§ ¨Ö§·ÓãËéÁÕ»ÃÐÊº¡ÒÃ³ì¨Ó¡Ñ´ àªè¹ ¡ÒÃÈÖ¡ÉÒ¢Í§ Wong et al,29 Haghbin et al,30 Frykholm et al31 «Öè§ÊèÇ¹ãËèãªé bolus 5FU based chemotherapy ÃèÇÁ¡Ñº¡ÒÃ©ÒÂÃÑ§ÊÕ 40-45 Gy ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ ¹Í¡¨Ò¡¹Õé¡çÁÕ¡ÒÃÈÖ¡ÉÒ¢Í§ EORTC32 «Öè§à»ç¹ randomized study ã¹¼Ùé»èÇÂ 247 ÃÒÂ ·Õèà»ç¹ÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·ÕèÊÒÁÒÃ¶·Ó¼èÒµÑ´ÍÍ¡ä´é â´Â¡ÒÃãªé¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ÃèÇÁ¡ÑºÂÒà¤ÁÕºÓºÑ´ 5FU (375 mg/m2 bolus day 1-4) à»ÃÕÂºà·ÕÂº¡Ñº¡ÒÃ©ÒÂÃÑ§ÊÕÍÂèÒ§à´ÕÂÇ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ áµè»ÃÔÁÒ³ÃÑ§ÊÕ·Õèãªéã¹¡ÒÃÈÖ¡ÉÒ¹Õéãªéà¾ÕÂ§ 3,450 cGy áÅÐ 230 cGy/fraction áÅÐàÇé¹ªèÇ§ÃÐÂÐàÇÅÒ·Ó¼èÒµÑ´à¾ÕÂ§ 2 ÊÑ»´ÒËì «Öè§äÁè¶×ÍÇèÒà»ç¹¡ÒÃÃÑ¡ÉÒµÒÁáºº»¡µÔ¸ÃÃÁ´Ò (unconventional) ·Õèâ´Â·ÑèÇä»á¹Ð¹ÓãËéãªé»ÃÔÁÒ³ÃÑ§ÊÕµÑé§áµè 4,500 cGy ¢Öé¹ä» (180-200 cGy/fraction) ã¹ÃÐÂÐàÇÅÒ 5-6 ÊÑ»´ÒËì áÅÐÁÕªèÇ§ËèÒ§ÃÐËÇèÒ§¡ÒÃ©ÒÂÃÑ§ÊÕ¡Ñº¡ÒÃ·Ó¼èÒµÑ´ 4-6 ÊÑ»´ÒËì «Öè§¼Å¡ÒÃÈÖ¡ÉÒ¹Õé äÁè¾ºÁÕ¤ÇÒÁáµ¡µèÒ§ã¹¡ÒÃ¤Çº¤ØÁâÃ¤à©¾ÒÐ·Õè ÍÂèÒ§äÃ¡çµÒÁ¼Ùé»èÇÂ¡ÅØèÁ·Õèä´éÃÑº¡ÒÃÃÑ¡ÉÒ·Ñé§¡ÒÃ©ÒÂÃÑ§ÊÕáÅÐà¤ÁÕºÓºÑ´ÃèÇÁ¡Ñ¹¡èÍ¹·Ó¡ÒÃ¼èÒµÑ´¾ºÇèÒÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§âÃ¤ä»·ÕèµÑº
Å´Å§ (8% VS 18%) áµèäÁè¾ºÇèÒÁÕ»ÃÐâÂª¹ìµèÍ¡ÒÃà¾ÔèÁÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂ
¨Ò¡¤ÇÒÁàª×èÍ·ÕèÇèÒ¡ÒÃãªé continuous infusion ¢Í§ 5FU ÍÒ¨¨Ðä´é»ÃÐâÂª¹ìÁÒ¡¡ÇèÒ¡ÒÃãªé bolus 5FU33 Rich34 ¨Ò¡Ê¶ÒºÑ¹ M.D. Anderson Hospital ¨Ö§ä´é·Ó¡ÒÃÈÖ¡ÉÒà»ÃÕÂºà·ÕÂº¡ÒÃ©ÒÂÃÑ§ÊÕ
4,500 cGy/25 fraction ã¹ÃÐÂÐàÇÅÒ 5 ÊÑ»´ÒËì ÃèÇÁ¡Ñº¡ÒÃãªé continuous infusion ¢Í§ 5FU
(250 mg/m2/d) µÅÍ´ªèÇ§ÃÐÂÐàÇÅÒ¢Í§¡ÒÃ©ÒÂÃÑ§ÊÕ áÅéÇ¨Ö§µÒÁ´éÇÂ¡ÒÃ·Ó¼èÒµÑ´ «Öè§¡ÓÅÑ§ÃÇºÃÇÁ¼Å¡ÒÃÈÖ¡ÉÒÍÂÙè áÅÐ¤§¨Ð·ÃÒº¤ÓµÍºã¹ªèÇ§àÇÅÒÍÑ¹ã¡Åé¹Õé
¹Í¡¨Ò¡¹ÕéÂÑ§ÁÕ¡ÒÃÈÖ¡ÉÒ¨Ò¡ MSKCC35,36 ·Õèãªé¡ÒÃ©ÒÂÃÑ§ÊÕÃèÇÁ¡Ñº 5FU áÅÐ low-dose leucovorin ¡èÍ¹·Ó¼èÒµÑ´ «Öè§¾ºÇèÒÁÕ¡ÒÃµÍºÊ¹Í§ÍÂèÒ§ÊÁºÙÃ³ì (complete response) ¶Ö§ 19% áÅÐ·ÓãËéÁÕÍÑµÃÒ¡ÒÃ·Ó¼èÒµÑ´ÍÍ¡ä´éËÁ´ 100% áµèÊÔè§·ÕèÊÓ¤ÑÍÕ¡ÍÂèÒ§¤×Í¾ºÁÕÀÒÇÐá·Ã¡«éÍ¹¨Ò¡¡ÒÃÃÑ¡ÉÒ·Õèà»ç¹ grade 3 toxicity ·Ñé§ËÁ´ 20% ·Õè¾ººèÍÂ¤×Í ·éÍ§àÊÕÂ (diarrhea), »Ç´·éÍ§»Ç´àºè§ÃØ¹áÃ§ (tenesmus) áÅÐ¼ÔÇË¹Ñ§à»×èÍÂá´§ (erythema)
¨Ò¡¢éÍÁÙÅµèÒ§ æ ·ÕèÁÕÍÂÙèã¹»Ñ¨¨ØºÑ¹ ªÕéá¹ÐÇèÒ¡ÒÃ©ÒÂÃÑ§ÊÕÃèÇÁ¡Ñº¡ÒÃãªéÂÒà¤ÁÕºÓºÑ´¡èÍ¹·Ó¡ÒÃ
¼èÒµÑ´ ¨Ðà¾ÔèÁâÍ¡ÒÊ¢Í§¡ÒÃ·Ó¼èÒµÑ´ÍÂèÒ§ÊÁºÙÃ³ì (complete resection) «Öè§¨Ðà»ç¹»ÃÐâÂª¹ìÍÂèÒ§ÁÒ¡ã¹¼Ùé»èÇÂ·ÕèÁÒ¾ºá¾·Âìã¹ÀÒÇÐ·ÕèäÁèÊÒÁÒÃ¶·Ó¼èÒµÑ´ä´éµÑé§áµèàÃÔèÁáÃ¡ «Öè§à»ç¹¼Å¨Ò¡¡ÒÃ·ÕèÁÕ¡ÒÃµÍºÊ¹Í§·Õè´Õ¢Í§¡ÒÃÃÑ¡ÉÒ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ áÅÐ¾ºÍØºÑµÔ¡ÒÃ¢Í§¡ÒÃá¾Ãè¡ÃÐ¨ÒÂä»·ÕèµèÍÁ¹éÓàËÅ×Í§Å´Å§ ·ÓãËéÁÕ¡ÒÃ¤Çº¤ØÁâÃ¤à©¾ÒÐ·Õèä´é´Õ¢Öé¹ áµèÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¹Ñé¹ÂÑ§äÁèÊÒÁÒÃ¶ºÍ¡ä´éá¹èªÑ´ «Öè§ÂÑ§¤§µéÍ§ÁÕ¡ÒÃµÔ´µÒÁ¼Å¡ÒÃÈÖ¡ÉÒµèÍä»

[Previous]	Toxicity
[Next]	Combined Pre and Postoperative Radiation
[Up]	Preoperative Radiotherapy in Rectal Adenocarcinoma
[Home]	Home Page

Last modified on 25 October 1996