新辅助治疗局部进展期低位直肠癌老年病人的疗效评估

Evaluation of neoadjuvant chemoradiotherapy (NCR) in patients over the age of 65 with locally advanced low rectal cancer

目的:探讨新辅助治疗对低位局部进展期(T3或T4)直肠癌老年病人(65岁以上)的疗效,并探讨其安全性。方法:分析2001年6月至2008年4月共105例的老年低位局部进展期直肠癌病人(距肛≤6cm)的临床资料。全部病例均先予以放疗(40～46)Gy/(20～23)次,每周5次,每次2Gy,休息2d,共4～5周。放疗结束休息6周后进行手术。在放疗同时进行化疗,口服卡培他滨1250mg/(m2·d),分2次口服,直至手术。手术按直肠全系膜切除(total mesorectal excision,TME)原则进行。结果:全部病人均完成了预定的新辅助治疗,其中67例出现副反应(其中有1例于放疗结束后的休息期间出现脑血管意外,经内科继续治疗3个月后再行手术切除)。8例(7.6%)病人经复查肿瘤完全消失,故未行手术,予随访观察。97例(92.4%)按TME原则行直肠癌根治术。手术标本显示:肿瘤已完全消失者12例(故加上未行手术的8例,经放、化疗肿瘤已完全消失者共20例);降期者59例(56%)。95例病人保肛手术,保肛率达90.5%。在行保肛手术病人中,发生吻合口漏5例(4.8%)。本研究的105例病人全部获得随访,随访期12～92个月,中位期为53个月。在随访期中,发现肺转移5例(4.8%)、肝转移3例(2.9%)、局部复发4例(3.8%),总复发率达11.43%;死亡12例,其中5例死于非肿瘤相关疾病。结论:新辅助放化疗在治疗过程中,降期作用明显、复发率低、耐受性好,是目前低位局部进展期直肠癌老年病人安全、合适的治疗方案。

Objective To explore the results of the neoadjuvant chemoradiotherapy（NCR） in patients over the age of 65 with locally advanced low rectal cancer and to evaluate the corresponding safety of the treatment.Methods Between June 2001 and April 2008,105 patients over the age of 65 with T3 and T4 low rectal cancer（distance from the tumor to the anal verge ≤6 cm） were treated by preoperative radiotherapy to the pelvis（2.0 Gy daily up to 40-46Gy in 4-5 weeks）,concomitantly with oral capecitabine（CAP） 1250 mg/m^2 dailydivided into 2 doses,continuously for 10 weeks up to the time of surgery.In all the patients,surgery was carried out according to the principle of TME.Results All the patients met the demands of the study,with 67 patients had suffering from advertse effects,including one patient having a cerebrovascular complication during a break after radiotherapy,so that his operation was carried out 3 months later.The tumor disappeared completely in 8 patients（7.6%） who were not operated upon there-after.A total of 97 patients（92.4%） were operated on according to the principle of TME.None of the patients had further development or metastasis of the tumor during the preoperative re-evaluation.As a result of examination of the surgical specimens,12 patients had a complete pathologic response,bringing to a total of 20 patients（19.0%） acquiring a complete clinical response in 59 patients（56%）,down-staging was obtained.Sphincter preservation was successful in 90.5%.Anastomotic leakage occurred in 5 patients（4.8%）.All the patients were followed-up for a period of 12-92 months,the median being 53 months.During the follow-up period,5 patients were found to develop lung metastasis,3 patients to have liver metastasis,and 4 patients（3.8%） to have local recurrence.Twelve patients died during the period,of which 5 died of non-tumor-related diseases.Conclusion In the treatment of low rectal carcinoma,NCR leads to tumor down-staging,and low recurrence rate;it is well tolerated in patients over the age of 65.