目的：評估局部侵犯性直腸癌患者接受術前同步化放療之治療成效。 材料與方法：回顧本院自西元 2006 年至 2013 年間，新診斷之局部侵犯性直腸癌，且於手術 前接受同步化放療的病例。排除診斷時已有轉移及最終沒有在本院接受手術者。放療總劑量 中位數為 5040 cGy，常用的同步化療藥物為 Capecitabine 或 Tegafur & Uracil。術前放化療結 束至手術間隔時間中位數為 8 周。使用 Kaplan-Meier 方法分析整體存活率（OS）、癌症存活率 （CSS）、骨盆腔無復發存活率（PRFS）、與無遠端轉移存活率（DMFS）。並分析影響病理完全 緩解率（pCR）之因子及不同手術方式的預後。 結果：166 位病人被納入本研究，追蹤時間中位數為 3.03 年。5 年的 OS 和 CSS 分別為 73%及 78%。無骨盆腔復發和無遠端轉移之存活時間中位數分別為 2.6 年及 2.2 年。病理完全緩解率 為 11.45%。化療藥物之選擇對存活率及病理完全緩解率無顯著影響。病患接受肛門保留手術之 比例為 77%，在距離 anal verge 小於 5 cm、5 到 10 cm、與超過 10 cm 之患者，接受肛門保留 手術的比例分別為 59%、87%、100%。腹腔鏡與傳統開腹手術之比較顯示：接受腹腔鏡手術之 患者有較少的骨盆腔內復發（11.1% v.s 25.6%, p= .036），較少的術中失血量（174 cc v.s 309 cc, p= .012），及較短的住院天數（8 days v.s 13 days, p= .000）。在存活分析方面，OS、CSS、PRFS 及 DMFS 於接受兩種術式之病人間，皆無統計上顯著差異。 結論：術前同步化放療為治療局部侵犯性直腸癌患者之有效方法。Capecitabine 與Tegafur & Uracil 這兩種藥物均可合併術前放射線治療使用。內視鏡腫瘤切除手術與開腹腫瘤切除手術相 較有相同的治療成果但相對較低的手術併發症。

Introduction : The purpose of this study is to evaluate preliminary outcomes in locally advanced rectal cancer patients who underwent neoadjuvant concurrent chemoradiotherapy (CCRT). Material and Method : From 2006 to 2013, 166 patients with newly diagnosed clinical stage II or III rectal cancer who received neoadjuvant CCRT were identified (cT2- 3=155, cT4=11, cN+=93). All of them received external beam radiotherapy (EBRT) with median dose of 5040 cGy (4400 - 5400 cGy). The regimens of chemotherapy combined with radiation were Capecitabine (47%), Tegafur & Uracil (40%) and others. Median duration from the end of neoadjuvant CCRT to surgery was 56 days (21 – 173 days). All radical surgery were done in a total mesorectal excision (TME) fashion. The end points of this study included overall survival (OS), cancer-specific survival (CSS), pelvic recurrence-free survival (PRFS), and distant metastasis-free survival (DMFS). We also analyzed factors associated with pathological complete response (pCR) and outcomes between different surgical procedures. Result : After a median follow-up duration of 3.03 years (0.22 – 8.16 years), 5-year OS rate was 73%, 5-year CSS rate was 78%, median PRFS was 2.6 ± 2 years, and median DMFS was 2.2 ± 2 years. There were no differences in OS (p= .776) and CSS (p= .717) between patients receiving Capecitabine or Tegafur & Uracil combined with radiation. We achieved pCR rate of 11.45%, and ratio of receiving anal-preservation surgery was 77% (59%, 87%, 100% for lower third, middle third, and upper third tumor, respectively). In subgroup analysis, laparoscopic surgery group had lower pelvic recurrence rate (11.1% v.s 25.6%, p= .036), less intra-operative blood loss (mean, 174 cc v.s 309 cc, p= .012), and shorter hospital stay (mean, 8 days v.s 13 days, p= .000). The 5-year OS rate was 78% for laparoscopic surgery group and 59% for open surgery group respectively (p = .126), the 5-year CSS rate was 80% and 72% (p= .572), median PRFS was 2.2 years and 4.6 years (p= .672), and median DMFS was 2 years and 3.5 years (p= .549). Conclusion : Neoadjuvant CCRT followed by surgery is a feasible way to treat locally advanced rectal cancer, and the 5-year OS rate was 73% in the current study. Capecitabine and Tegafur & Uracil are reasonable choices as concurrent regimens. Laparoscopic surgery is recommended due to lower surgical morbidities and noninferiority of outcomes.