Radiation Oncology, Chulolongkorn University : Combined Pre and Postoperative Radiation

Radiation Oncology Chulolongkorn University

Combined Pre and Postoperative Radiation

ÁÕËÅÒÂÊ¶ÒºÑ¹·ÕèàÅ×Í¡ãªé¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ â´Âãªéáºº low dose ¤×ÍãËé»ÃÔÁÒ³ÃÑ§ÊÕ
500-2,000 cGy áÅéÇ¨Ö§·Ó¡ÒÃ¼èÒµÑ´ ËÅÑ§¨Ò¡¹Ñé¹¡ç¨ÐãËé¡ÒÃ©ÒÂÃÑ§ÊÕà¾ÔèÁàµÔÁÍÕ¡áºº High dose postoperative radiation ¶éÒ¾ºÇèÒ¼Ùé»èÇÂ´Ñ§¡ÅèÒÇà»ç¹¡ÅØèÁ«Öè§ÁÕÍÑµÃÒàÊÕèÂ§µèÍ¡ÒÃ¡ÓàÃÔº¢Í§âÃ¤à©¾ÒÐ·ÕèÊÙ§
(stage B2 áÅÐ C)
·Õè The Thomas Jefferson University Hospital37 ä´éãªé¡ÒÃ©ÒÂÃÑ§ÊÕ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´´éÇÂ low dose »ÃÔÁÒ³ÃÑ§ÊÕ 500 cGy à¾ÕÂ§¤ÃÑé§à´ÕÂÇ áÅÐµÒÁ´éÇÂ¡ÒÃ©ÒÂÃÑ§ÊÕËÅÑ§¨Ò¡·Ó¡ÒÃ¼èÒµÑ´áÅéÇÍÕ¡ 4,500 cGy ¾ºÇèÒ¼Ùé»èÇÂÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ 5 »Õ ËÅÑ§ÃÑ¡ÉÒ 91% ã¹ÃÐÂÐ A áÅÐ B1, 72% ã¹ÃÐÂÐ B2 áÅÐ C
«Öè§ÊÙ§¡ÇèÒ¼Ùé»èÇÂ·ÕèÃÑ¡ÉÒâ´Âãªé¡ÒÃ©ÒÂÃÑ§ÊÕáºº low dose ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´ËÃ×Í·Ó¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ â´Â¾ºÇèÒÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè 5 »Õ à·èÒ¡Ñº 52% áÅÐ 34% µÒÁÅÓ´Ñº
¹Í¡¨Ò¡¹ÕéÂÑ§ÁÕÃÒÂ§Ò¹¨Ò¡ MGH38 áÅÐ MSKCC39 ·Õè·Ó¡ÒÃÈÖ¡ÉÒàªè¹à´ÕÂÇ¡Ñ¹ áÅéÇ»ÃÒ¡¯ÇèÒÊÒÁÒÃ¶à¾ÔèÁÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ¢Í§¼Ùé»èÇÂ ËÃ×Í¡ÒÃÈÖ¡ÉÒ¨Ò¡ RTOG/ECOG40 ·Õèà»ç¹ randomized study
â´Âà»ÃÕÂºà·ÕÂº¡ÒÃãªé combined pre áÅÐ postoperative radiation àªè¹¡Ñº·Õè Jefferson ãªéÍÂÙè ¡Ñº¡ÒÃ©ÒÂ
ÃÑ§ÊÕËÅÑ§¼èÒµÑ´ÍÂèÒ§à´ÕÂÇ «Öè§¼Åã¹ÃÐÂÐàº×éÍ§µé¹·Õè 3 »Õ ¾ºÇèÒÁÕÍÑµÃÒ¡ÒÃ¤Çº¤ØÁâÃ¤à©¾ÒÐ·Õè´Õ¢Öé¹ 10%
¤×Í 79% áÅÐ 69% µÒÁÅÓ´Ñº áµèäÁèÁÕ¤ÇÒÁáµ¡µèÒ§¢Í§ÍÑµÃÒ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢Í§âÃ¤ (distant metastasis) áÅÐÁÕÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµ·Õè´Õ¢Öé¹ (75% VS 68%) áµèäÁèÁÕ¹ÑÂÊÓ¤Ñ·Ò§Ê¶ÔµÔ ÍÂèÒ§äÃ¡çµÒÁ¤§¨ÐµéÍ§µÔ´µÒÁ¼Å¡ÒÃÃÑ¡ÉÒµèÍä»ãËéÂÒÇ¹Ò¹¢Öé¹ à¾×èÍ·Õè¨ÐÊÒÁÒÃ¶Â×¹ÂÑ¹ãËéá¹èªÑ´ÇèÒÁÕ»ÃÐâÂª¹ìµèÍ·Ñé§¡ÒÃ¤Çº¤ØÁâÃ¤à©¾ÒÐ·ÕèáÅÐÍÑµÃÒ¡ÒÃÃÍ´ªÕÇÔµÍÂèÒ§ã´ËÃ×ÍäÁè
The Thomas Jefferson University Hospital (TJUH) ä´éÁÕ¡ÒÃàÊ¹Íá¹Ç·Ò§¡ÒÃÃÑ¡ÉÒÁÐàÃç§ÅÓäÊéãËèÊèÇ¹ rectum ·Õè¹èÒÊ¹ã¨ â´ÂÁÕ¡ÒÃ¨Ñ´áºè§¼Ùé»èÇÂÍÍ¡µÒÁ clinical staging ´Ñ§áÊ´§ã¹µÒÃÒ§·Õè 7 â´ÂãËé¤ÇÒÁÊÓ¤Ñ¢Í§¡éÍ¹ÁÐàÃç§¹Ñé¹ ÇèÒÁÕ¡ÒÃà¤Å×èÍ¹·ÕèËÃ×Íà¡ÒÐµÔ´¡ÑºÍÇÑÂÇÐ¢éÒ§à¤ÕÂ§ (mobility/fixation)
à»ç¹µÑÇºè§ªÕé·ÕèÊÓ¤Ñ·Ò§¤ÅÕ¹Ô¤ÇèÒ¨ÐàÅ×Í¡ãªéÇÔ¸Õ¡ÒÃ©ÒÂÃÑ§ÊÕáººã´áÅÐãËé»ÃÔÁÒ³ÃÑ§ÊÕÊÙ§ÁÒ¡¹éÍÂà¾ÕÂ§ã´
«Öè§ä´éáÊ´§´Ñ§ÃÙ»·Õè 1
â´Â·Õè¼Ùé»èÇÂ«Öè§¨Ñ´ÍÂÙèã¹¡ÅØèÁ·Õè´Õ (favorable) ¤×ÍµÑÇÁÐàÃç§äÁèà¡ÒÐµÔ´¡ÑºÍÇÑÂÇÐÍ×è¹áÅÐÁÕ¡ÒÃà¤Å×èÍ¹µÑÇ¢Í§¡éÍ¹ÁÐàÃç§ä´é·Ø¡·ÔÈ·Ò§ ¡ÅØèÁ¹Õé¨Ðãªé¡ÒÃ©ÒÂÃÑ§ÊÕáºº low dose ¡èÍ¹¡ÒÃ·Ó¼èÒµÑ´â´Âãªé»ÃÔÁÒ³ÃÑ§ÊÕ 500 cGy à¾ÕÂ§¤ÃÑé§à´ÕÂÇ áÅéÇµÒÁ´éÇÂ¡ÒÃ·Ó¼èÒµÑ´·Ñ¹·Õ «Öè§¨ÐäÁè·ÓãËéÁÕ¡ÒÃà»ÅÕèÂ¹á»Å§ÃÐÂÐ¢Í§âÃ¤ áÅÐºÒ§¤¹àª×èÍÇèÒ¨Ð·ÓãËé¤ÇÒÁÃØ¹áÃ§¢Í§ÁÐàÃç§Å´¹éÍÂÅ§ âÍ¡ÒÊ·ÕèÁÐàÃç§¨ÐÁÕ¡ÒÃá¾Ãè¡ÃÐ¨ÒÂ¢³Ð·Ó¼èÒµÑ´¡ç¨ÐÅ´Å§´éÇÂ áÅÐ¶éÒÃÒÂ§Ò¹¢Í§¼ÅªÔé¹à¹×éÍÇèÒà»ç¹ÃÐÂÐ Dukes’A áÅÐ B1 ¡çäÁèµéÍ§ãËé¡ÒÃÃÑ¡ÉÒà¾ÔèÁàµÔÁ áµè¶éÒËÒ¡à»ç¹ÃÐÂÐ Dukes’B2 áÅÐ C ¡ç¾Ô¨ÒÃ³ÒãËé¡ÒÃ©ÒÂÃÑ§ÊÕà¾ÔèÁÍÕ¡ 4,500 cGy ã¹ÃÐÂÐàÇÅÒ 5 ÊÑ»´ÒËì (selective postoperative radiation)

µÒÃÒ§·Õè 7 Clinical Classification of Rectal Cancer (TJUH)

Stage I	Mobile	Free movement in all direction
Stage II	Partially fixed	Movable in at least one direction
Stage III	Fixed	Immovable in any direction due to fixation or perforated, obstructed, deeply ulcerated
Stage IV	Frozen pelvs	Invasion of pelvic ide walls and/or sacrum-unresectable

ÃÙ»·Õè 1 Thomas Jefferson University Hospital schema for management of rectal cancer

[Previous]	Preoperative radiation and chemotherapy
[Next]	Conclusion
[Up]	Preoperative Radiotherapy in Rectal Adenocarcinoma
[Home]	Home Page

Last modified on 25 October 1996