术前放化疗对低位直肠癌保肛手术作用的临床研究

Clinical effect of preoperative radiotherapy and chemotherapy on sphincter preserving surgery in advanced low rectal cancer

目的探讨术前放化疗对中晚期低位直肠癌保肛手术的作用价值。方法43例低位中晚期直肠癌患者,术前予3野或4野盆腔照射,总剂量45 Gy/5周,每周5次,每次1.8 Gy,并于放疗第1、3周同步四氢叶酸钙200 mg/m^2,静脉输注d1-d5,氟脲嘧啶500 mg/m^2,静脉输注12 h d1-d5化疗,完成放化疗后,4-6周手术,术后2-4周,追加2-4周期化疗。结果治疗前T320例,T423例。放化疗后,CR 6例,PR 19例,NC 18例,降期25例,降期率58.1%;3例肿瘤完全消失,未手术。40例行直肠癌根治性手术,其中29例为保肛手术,11例为经腹会阴直肠手术,保肛率为74.4%（32/43）,包括3例未手术者。术后随访13-59个月,中位随访时间34个月,随访无局部复发,1例伴有肝转移,无死亡,总复发率为2.33%（1/43）,无瘤生存率97.67%（42/43）。结论低位直肠癌术前放化疗能缩小肿瘤,降期,提高肿瘤的切除率和保肛成功率,降低局部复发,延长生存时间。

Objective To investigate the value of preoperative radiotherapy and chemotherapy in sphincter preserving surgery in advanced low rectal cancer.Methods 43 patients with advanced low rectal cancer underwent preoperative 3 or 4 pelvic field irradiation,at the dosage of 45 Gy/5 weeks,5 times a week,with 1.8 Gy each.They were given simultaneously calcium folinate 200 mg/m2（intravenous dripping 1-5 days） and fluorouracil 500 mg/m2（intravenous dripping 12 hours,1-5 days） in the 1st and 3rd weeks of radiotherapy.Subsequent to radiotherapy and chemotherapy,surgery was performed from the 4th to 6th week.Additional 2-4 cycles of chemotherapy were appended 2-4 weeks after operation.Results Of the 20 cases of T3 stage and 23 cases of T4 stage undergoing radiotherapy and chemotherapy,there were 6 cases of complete remission（CR）,19 cases of partial remission（PR）,18 cases of no change（NC）,25 cases of down-staging at a proportion of 58.1%,and 3 cases of complete tumor disappearance without operation.Of the 40 cases of radical surgery of rectal cancer,29 cases underwent sphincter preserving surgery and 11 cases had abdominal-perineal rectal surgery,at a sphincter-saving rate of 74.4%（32/43）,including 3 cases without surgery.Post-operative follow-up of 13-59 months,with the median follow-up time of 34 months revealed that there was no local recurrence,1 case had hepatic metastasis and there was no death,the total recurrence rate being 2.33%（1/43） and disease-free survival rate being 97.67%（42/43）.Conclusion Preoperative radiotherapy and chemotherapy in advanced low rectal cancer surgery can reduce the size of tumor,decrease tumor staging,increase excision rate of tumor and success rate of sphincter preserving,depress local recurrence and extend survival time