局部晚期直肠癌术前放化疗的效果评价

Efficacy of preoperative chemoradiotherapy in treatment of local advanced rectal cancer

目的评价局部晚期直肠癌术前放化疗的效果及毒副作用。方法对16例局部晚期直肠癌患者行术前放化疗,放疗总剂量为45Gy,每周5次,每次1．8Gy。同时配合全身化疗,方案:亚叶酸钙(CF)100mg,静脉滴注,随后静脉给予5-氟脲嘧啶(5-FU)300mg/m2,第1-5天,第22-26天,共2个周期,放化治疗完成后4-6周行手术治疗。结果术前放化治疗后T分期下降10例(62．50％),N分期下降8例(50．00％),降低临床分期率为56．25％(9/16),总有效率为68．75％(11/16)。根治性切除16例(100．00％)。随访14例未发现局部复发、远处转移及死亡病人。9例保肛术病人肛门括约肌功能正常。结论术前放化疗可缩小原发肿瘤体积,减少局部淋巴结转移率,降低肿瘤分期,提高手术的切除率和保肛率,且毒副作用可耐受。

Objective To assay the patients with local advanced rectal cancer. efficacy and toxicities of preoperative chemoradiotherapy in treatment of Methods Sixteen patients with local advance rectal cancer received preoperative chemoradiotherapy. The protocol was carried out in sequence of chemotherapy to radiotherapy to surgery. The treatment began with preoperative chemotherapy with folic acid （CF） 100mg i.v. followed by 5 - fiuorouracil （5 -FU） i.v. bolus of 300mg/m^2 given two cycles on days 1-5 and on days 22-26 before irradiation. Radiotherapy was delivered to a total dose of 45Gy, 1.8Gy per fraction, 5 times a week. Surgery was done 4-6 weeks after this preoperative treatments. Results After preoperative chemoradiotherapy, ten patients in stage T got remission with a ratio of 62.50%, eight patients got remission with a ratio of 50.00%, clinical remission rate was 56.25% （9/16）, the total effective rate was 68.75 % （11/16）. Sixteen patients （100 % ） underwent radical surgery. Fourteen patients got follow- up, no recurrence, no distant metastases, and no deaths had been observed. The function of external sohincter muscle of anus was normal in nine patients undergone anal sphincteroplasty. Conclusion Preoperative chemoradiotherapy is proved as a safe with a tolerable adverse effects. Shrinkage of the primary tumor and decrease in lymph node metastasis are observed after preoperative chemoradiothery regimen. An overall benefit of downstaging the tumor and greatly enhancing the efficacy of surgery is enjoyed by the patients.