臨床外科60巻1号

2005年01月発行

特集 手術のグッドタイミング 〔根治術のタイミング〕

放射線・放射線化学療法後の直腸癌手術

著者： 渡邉聡明¹ 武藤徹一郎² 名川弘一¹

所属機関： ¹東京大学医学部腫瘍外科 ²癌研究会附属病院

ページ範囲：P.23 - P.29

要旨：補助療法としての放射線療法による直腸癌術後の局所再発率の低下は大規模なRCT（randomized controlled trial）あるいはメタアナリシスによって報告されているが，術後生存率に関しては，有意な上昇が認められた報告がある一方，有意な差が認められないとする報告もあるのが現状である．手術を行う場合の照射のタイミングとしては，術前，術中，術後放射線療法があり，これらのうちでは術前放射線療法が有効であるとするRCTの結果が報告されている．術前放射線療法では，照射後の手術のタイミングが問題となるが，RCTによって照射直後よりも照射の6～8週間後に手術を行ったほうが良好な成績が報告されている．

参考文献

1）Frykholm GJ, Glimelius B, Pahlman L：Preoperative or postoperative irradiation in adenocarcinoma of the rectum：final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36：564-72, 1993

2）Roh MS, Colangelo L, Wieand S, et al：Response to preoperative multimodality therapy predicts survival in patients with carcinoma of the rectum. Journal of Clinical Oncology, ASCO Annual Meeting Proceedings（Post-Meeting Edition）22：3505, 2004

3）Sauer R, Fietkau R, Wittekind C, et al：Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer：the German trial CAO/ARO/AIO-94. Colorectal Dis 5：406-415, 2003

4）Watanabe T, Tsurita G, Muto T, et al：Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers. Surgery 132：27-33, 2002

5）Nagawa H, Muto T, Sunouchi K, et al：Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44：1274-1280, 2001

6）Francois Y, Nemoz CJ, Baulieux J, et al：Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer：the Lyon R90-01 randomized trial. J Clin Oncol 17：2396-2402, 1999

7）Stein DE, Mahmoud NN, Anne PR, et al：Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum 46：448-453, 2003

8）Moore HG, Gittleman AE, Minsky BD, et al：Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum 47：279-86, 2004.

9）Swedish Rectal Cancer Trial：Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. New Engl J Med 336：980-987, 1997

10）MacFarlane JK, Ryall RD, Heald RJ：Mesorectal excision for rectal cancer. Lancet 341：457-460, 1993

11）Enker WE, Thaler HT, Cranor ML, et al：Total mesorectal excision in the operative treatment of carcinoma of the rectum. Journal of the American College of Surgeons 181：335-46, 1995

12）Kapiteijn E, Marijnen CA, Nagtegaal ID, et al：Dutch Colorectal Cancer Group：Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. New Engl J Med 345：638-46, 2001

13）Camma C, Giunta M, Fiorica F, et al：Preoperative radiotherapy for resectable rectal cancer：A meta-analysis. JAMA 284：1008-15, 2000

14）Colorectal Cancer Collaborative Group：Adjuvant radiotherapy for rectal cancer：a systematic overview of 8, 507 patients from 22 randomised trials. Lancet 358：1291-304, 2001

15）Fisher B, Wolmark N, Rockette H, et al：Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer：results from NSABP protocol R-01. Journal of the National Cancer Institute 80：21-29, 1988

16）Wolmark N, Wieand HS, Hyams DM, et al：Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum：National Surgical Adjuvant Breast and Bowel Project Protocol R-02. Journal of the National Cancer Institute 92：388-396, 2000

17）Krook JE, Moertel CG, Gunderson LL, et al：Effective surgical adjuvant therapy for high-risk rectal carcinoma. New Engl J Med 324：709-715, 1991

18）Anonymous. Gastrointestinal Tumor Study Group：Radiation therapy and fluorouracil with or without semustine for the treatment of patients with surgical adjuvant adenocarcinoma of the rectum. Journal of Clinical Oncology 10：549-557, 1992

19）Tveit KM, Guldvog I, Hagen S, et al：Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group. Br J of Surg 84：1130-1135, 1997

20）O'Connell MJ, Martenson JA, Wieand HS, et al：Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. New Engl J of Med 331：502-527, 1994