术前放化疗联合手术治疗低位局部晚期直肠癌19例疗效观察

PREOPERATIVE CHEMORADIOTHERAPY PLUS SURGERY FOR LOCALLY ADVANCED LOWER RECTAL CARCINOMA

目的探讨术前放化疗联合手术治疗低位局部晚期直肠癌的临床价值。方法2001年2月-2004年12月本院肿瘤科共对19例低位局部晚期直肠癌患者采用术前放化疗联合手术治疗方案。术前放疗总剂量45Gy，每周5次，每次1．8Gy，同时联合奥沙利铂、甲酰四氢叶酸钙2、5-氟尿嘧啶同步化疗。放化疗结束6周后行手术治疗。结果经过术前放化疗治疗，原发病灶平均直径由4．6cm缩小为2．5cm（P〈0．05）；57．9％的病例T降期，58．3％的病例N降期。全组74％（14／19）的病例采用保留肛门手术，26％（5／19）的患者采用腹会阴联合切除术。术后病理手术标本呈轻度反应2例、中度反应5例、重度反应11例，肿瘤消失2例。结论对低位局部晚期直肠癌患者采用新辅助治疗，可使肿瘤分期降低，提高手术切除率和保肛率。

Objective To explore the clinical value of preoperative chemoradiotherapy combined with sugery for locally advanced lower rectal carcinoma. Methods From Feb 2001 to Dec 2000, 19 cases with locally advanced lower rectal carcinoma received a new regimen of combined preoperative chemotherapy with radiotherapy. Radiotherapy was given with a total dose of 45 Gy, 5 times per week, with 1.8 Gy per fraction. Patients received oxaliplatin 130 mg/m^2 （infusion） on day 1, plus leucovorin 200 r mg/m^2 and 5-Fu 500 mg/m^2（intravenous bolus） from day 1 to day 3 for two cycles before irradiation. Operation was performed 4 to 6 weeks later after neoadjuvant therapy. Results After preoperative chemoradiotherapy, the average diameter of tumor decreased from 4.6 cm to 2.5 cm. Tumor stage decreased in 57.9 % and nodal stage decreased in 58.3 % patients. Radical resection was performed in all patients, of whom 14（74% ） received sphincter-preserving surge and 5（26 % ） received abdominoperineal resection. Pathological examination showed： 2 cases had slight pathologic response, 5 cases had middle pathologic response, 11 cases had severe patho- logic response and complete pathologic response in 2 patients. Conclusion Combined preoperative chemoradiotherapy with surgery is a better therapy for lower advanced rectal cancer, which can de- crease tumor stage, improve respectability and anal sphincter preservation rate. Furthermore, the tolerable toxicity makes it a promising clinical management.