直肠癌患者术前联合放疗化疗与单纯放疗的疗效比较

Efficacy comparison of neoadjuvant radiotherapy with or without chemotherapy for locally advanced rectal cancer

目的探讨联合放化疗与单纯放疗对中低位局部进展期直肠癌疗效的影响。方法回顾性分析北京协和医院1997年10月至2007年10月间69例中低位直肠癌患者在予以新辅助治疗后施行根治性手术治疗的临床资料。结果术前单纯予以放疗者40例，放化疗联合者29例。全组患者肿瘤距肛缘3～10（平均5）cm。施行腹会阴联合切除术26例，低位前切除术27例．Parks术10例，Hartmann术6例；保肛率53．6％（37／69），其中单纯放疗组为47．5％（19／40），联合放化疗组为62．1％（18／29）；两组比较差异无统计学意义（X^2=1．435，P〉0．05）。29例患者肿瘤分期降低，其中联合放化疗组降期率58．6％（17／29），单纯放疗组30．0％（12／40），两组比较差异有统计学意义（X^2=5．65，P〈0．05）。术后病理显示肿瘤完全消退（CR）7例，其中联合放化疗组4例（13．8％），单纯放疗组3例（7．5％）；肿瘤部分缓解（PR）40例，其中联合放化疗组19例（65．5％），单纯放疗组21例（52．5％）；无效（NR）22例，其中联合放化疗组6例（20．7％），单纯放疗组16例（40．0％）；总有效率（CR加PR）68．1％（47／69），其中联合放化疗组为79．3％（23／29），单纯放疗组为60．0％（24／40）；两组比较差异无统计学意义（X^2=2．89，P〉0．05）。全组3年无病生存率77．3％。结论联合放化疗应用于直肠癌新辅助治疗在肿瘤降期和缓解率方面优于单纯放疗组，直肠癌新辅助治疗中应联合应用放化疗。

Objective To evaluate the efficacy of neoadjuvant radiotherapy alone versus chemoradiotherapy in patients with mid-low locally advanced rectal cancer. Methods Data of 69 patients with advanced （stage T3 or T4） rectal cancer, undergone neoadjuvant therapy in our hospital from October 1997 to October 2007, were analyzed retrospectively. Forty patients received preoperative radiotherapy （50 Gy in 25 fractions over 5 weeks） alone （RT group）, and 29 patients received preoperative radiotherapy concomitant with 5-FU/leucovorin -based preoperative chemoradiotherapy （CRT group）. Radical surgery was performed 4-6 weeks after radiation therapy by the rule of TME. Results All the patients underwent operations, including 26 abdominoperineal resections, 27 anterior resections, 10 Parks operations and 6 Hartmann＇s procedures. The sphincter preservation rate was 47.5% （19/40） in RT group, and 62.1%（18/29） in CRT group（P〉0.05）. In pathological findings, tumor and nodal downstaging were observed in 12 patients of RT group （30.0%）, and 17 of CRT group （58.6%） （P〈0.05）. In RT group, 3 patients （7.5%） showed pathological complete regression （pCR）, and the overall response rate （CR plus PR） was 60%（24/40）. In CRT group, 4（13.8%） showed pCR and the overall response rate was 79.3%（23/29）. There was significant difference of the overall response rate between two groups. Three-year disease-free survival for all patients was 77.3%. Conclusion For patients with locally advanced rectal cancer, neoadjuvant chemoradiotherapy provides higher sphincter preservation rate, overall response rate and better down-staging as compared to radiotherapy alone.