新辅助治疗在进展期低位直肠癌术前的应用

Effect of neoadjuvant therapy in treatment for advanced lower rectal cancer

背景与目的：提高进展期低位直肠癌的根切率和保肛率是一个难题，本研究探讨术前联合放化疔（新辅助治疗）在进展期低位直肠癌中的疗效。方法：23例进展期低位直肠癌患者，按术前评价均需行腹-会阴联合切除术的患者进行术前联合放化疗。放疔每周5d，每次200cCy，共4周20次，总剂量4000cGy。化疗的给药方式以放疔期间持续静脉滴注，采用草酸铂（Oxa）130mg/（m^2·d1），5-FU 500mg/（m^2·d1-5），加CF300mg/（m^2·d1-5），休息4～6周进行手术。结果：15例的病例肿瘤分期降级，施行了保留肛门的直肠癌根治术，保肛率达65％（15／23），其中82％的患者肛门括约肌功能良好。结论：进展期低位直肠癌的患者在接受新辅助治疗后，能使肿瘤降期，切除率增加，提高保肛率，同时副反应轻，患者依顺性较好。

Background and purpose： It is difficult to improve the curative resection rate and anal preservation rate of advanced lower rectal cancer, so we investigated the effect of preoperative chemoradiotherapy （neoadjuvant therapy） in treatment for advanced lower rectal cancer. Methods： A total of 23 advanced lower rectal cancer patients who had indications for abdominal-per rection（APR） according to preoperative evaluation were first treated with preoperative ehemoradiotherapy. Patients received radiotherapy five times a week at a dose 200 cGy daily up to 4 000 cGy in 4 weeks. Concomitantly patients received continuous venous chemotherapy of OXA 130 mg/（m^2·d1）, 5-Fu （500 mg/m^2·D1-5）, and CF （300 mg/m^2·d1-5）. Surgical operations were performed 4-6 weeks after neoadjuvant therapy. Results： Tumor stages were down-staged and eurative resection with sphineter saving operation were carried out in 15 of 23 patients. The rate of sphineter preservation was 65% （15/23）, in which, 82% patients showed good function of sphineter. Conclusions： Neoadjuvant therapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, increase of resectability and sphincter preservation. The side effects were mild and well tolerated.