直肠癌术前放射治疗的相关组织病理学观察报告

Histopathological Changes after Preoperative Radiotherapy in Rectal Cancer

目的 观察直肠癌术前放射治疗后组织病理学变化。方法 将 80例pTNMⅡ期和Ⅲ期直肠癌患者按入院先后次序 ,分为对照组和放射治疗组 ,每组 40例。使用西门子M 6740直线加速器 ,采用前后对穿射野和等中心剂量 ,总剂量为 40Gy ,每次剂量为 2Gy ,共 2 0次。放疗结束后 1～ 2周手术。治疗前后 ,在直视下分别钳取距癌灶 2cm的正常黏膜和肿瘤组织 ,经常规处理后进行病理组织学观察。结果 放射治疗组 40例患者中 ,直肠癌消退分级 (RCRG ) 1级 14例 ( 3 5 .0 % ) ,2级 18例 ( 4 5 .0 % ) ,3级 8例 ( 2 0 .0 % )。放疗组坏死发生率为 72 .5 % ,对照组为 45 .0 % (P =0 .0 0 4) ;放疗组间质组织纤维化变性率和血管内膜增厚分别为 80 .0 %和 77.5 % ,而对照组分别为 2 0 .0 %和 40 .0 % (P =0 .0 0 0 1和P =0 .0 0 1)。结论 直肠癌术前放射治疗可以使癌组织坏死 ,癌组织和间质产生纤维变性 ,降低了分期 。

Objective To investigate the histopathological changes after preoperative radiotherapy in rectal cancer.Methods 80 patients with pTNM stage Ⅱ or Ⅲ rectal cancer who were admitted between April 2000 and December 2002 were randomly assigned to receive either surgery alone or preoperative adjuvant radiotherapy.The totle dose of radiotherapy was 40 Gy with 2 Gy fractions every time.The radiotherapy lasted 4 weeks and was followed by 1～2 weeks rest.Pathological changes after preoperative radiotherapy included tumoural necrosis and changes of matrix and vessels.Results After preoperative radiotherapy,significant tumor regression(RCRG 1) was seen in 14 cases(35.0%) and partially tumor regression(RCRG 2) in 18 cases(45.0%).Significant necrosis was observed in 72.5% of cases and most of the foci of adenocarcinoma were replaced by fibrosis in 80% of the cases.The thicken of intima of most vessels were seen in 77.5% of cases.These pathological changes after radiotherapy was significant.Conclusion More necrosis,fibrosis and thicken of vascular intima happen in rectal cancer tissue in patients with preoperative radiotherapy than without.Resection and sphincter-saving rates increase after radiotherapy.