局部进展期低位直肠癌术前同步放化疗疗效初步观察

Efficacy of preoperative concurrent chemoradiotherapy in treatment of locally advanced rectal cancer

目的:评价术前同步放化疗治疗局部进展期低位直肠癌的安全性及有效性。方法:对2005年8月～2007年8月收治的30例局部进展期低位直肠癌患者行术前放化疗。术前放疗:6MVX线,SAD=100cm,总剂量46Gy,200cGy/f,5f/w。术前同步化疗:2周期5-氟尿嘧啶(5-Fu)+亚叶酸钙(CF)方案化疗。放化疗后4～6周行手术治疗。术式选择依据患者情况而定,包括全直肠系膜切除(TME)、腹会阴联合切除术(Miles术)、低位或超低位前切除术(Dixon术)、腹肛式切除吻合术(Parks术)。结果:全部患者均完成治疗。1、2级毒性反应总发生率为66.7%,3、4级为20%。同步放化疗后T分期下降率为60%,N分期下降率为40%。术后病理学完全缓解(CR)率为13.3%,保肛率为46.7%。手术并发症发生率为20%。结论:术前同步放化疗对于治疗局部进展期低位直肠癌安全有效,降低肿瘤分期、提高保肛率的同时改善了患者的生存质量。

Objective： To evaluate the safety and efficacy of preoperative concurrent chemoradiotherapy in locally advanced low rectal cancer. Methods： 30 patients with newly diagnosed locally advanced low rectal cancer were finally included in this study. Total mesorectal excision （TME）, Abdominoperineal resection （Miles）,low anterior resection （Dixon）and Anal-abdominal resection anastomosis （Parks） were chosen appropriately according to patients＇ situation. The irradiation regimen was： 6MV X -ray , SAD =100 cm, total dose 46 Gy and 200 cGy/f,5 f/w. The concurrent chemotherapy regimen was 5-Fu plus CF for 2 courses. Surgery was performed on 4-6 weeks after chemoradiation. Results： All the patients completed the planned treatment. The rate of Grade 1,2 acute toxicity was 66.7% and Grade 3,4 was 20%. 60% patients had a T downstaging and 40% patients had a N dowstaging. A complete pathological remission was observed in 4 cases （13.3%） and the sphincter preservation rate was 46.7%. Complications after operation was 33.3%. Conclusion： Preoperative concurrent chemoradiotherapy is feasible and effective. It improves clinical stage, sphincter preservation and the quality of life in patients with locally advanced low rectal cancer.