局部晚期直肠癌术前放疗的病理和临床研究

Pathological and Cinical Research on Preoperadve Radio Therapy for Local Advanced Rectal Cancer

目的：观察局部晚期直肠癌术前放疗后病理学变化和临床疗效。方法：选择我院2005年6月至2007年10月收治的肿瘤局部粘连或固定的直肠癌患者44例，采用随机分组，其中22例行术前放疗（放疗组），另外22例行单纯手术治疗。采用6MVX线加大分割的三维适形放疗，DT：46Gy／20f，放疗后4～6周手术。结果：放疗组术后病理证实：直肠癌消退分级1级占5例，2级占16例，3级占1例。临床分期变化：T期下降15例（68．2％），手术切除率放疗组和手术组分别为86．4％、63．6％，P〈0．05，差异有显著性。术前放疗反应可耐受．且并未增加远期并发症。结论：局部晚期直肠癌术前放疗可提高肿瘤手术切除率，降期显著，并不增加手术难度和并发症。

Objective：To investigate the pathologic changes and clinical effects of preoperative irradiation on local advanced rectal cancer. Methods： From June 2005 to Octobor 2007, 44patients with tethered and fixed rectal cancer were randomly divided into tWO groups. 22 patients were treated by preoprative radiotherapy（the irradiation group）, and the others 22 were treated by operation alone. The irradiation group received 6 MV X ray three-dimension conformal radiation therapy, witll total tumor dose（DT）of 46Gy/20f/4W. The operation was per- formed 4-6 weeks after radiation. Results： In the irradiation group, the pathologic response after operation prove： the significant tumor regression（RCRG1）was seen in 5 cases, the partially tumor regression（RCRG2）was seen in 1 6 cases, and 1 case was RCRG3. T- stage was lowered in 15 of patients. The tumor operative resective rate in irradiation group and operation group was 86.4 %, 63.6 %. Conclusions： Preoperative irradiation might enhance the tumor operative resective rate in tethered and fixed rectal cancer. It Can reduce T - stage significantly. And the acute radiation toxicitv was tolerable without increasing operative difficulty and complications.