新辅助放化疗在中晚期低位直肠癌全直肠系膜切除术的作用

Neoadjuvant Chemoradiotherapy for Advanced Rectal Cancer with Total Mesorectal Excision Role

目的:探讨2种新辅助放化疗(NCR)在中晚期直肠癌全直肠系膜切除术的作用。方法:78例T3、T4期低位直肠癌随机分为两组,每组39例。全部给予放疗,每次2Gy,总剂量45～50Gy,每周5次。A组同时辅以5-氟尿嘧碇(F-FU)、亚叶酸钙治疗(LV),B组同时辅以希罗达(Xeloda)治疗。放疗结束休息6周后进行手术。手术均按全直肠系膜切除术操作规范进行。结果:全部病人按计划完成NCR,其中11例肿瘤完全消失,未行手术。67例施行了根治性切除术,65例为保肛手术。2例为腹会阴切除术。病理结果显示10例肿瘤消失(TO)。总的肿瘤消失为21例。T2No13例,T3No26例,T2-3No18例,无T4期。共52例(66.67%)达到降期(down staging)。全组随访6～42个月。无局部复发,4例肺转移,总复发率5.13%,无死亡,无瘤生存和无复发生存率均为94.87%。结论:NCR与全直肠系膜切除术操作规范相结合有效地达到肿瘤降期的目的,肿瘤缩小,切除率和保肛率均明显增加,降低了复发的风险。

Objective： Of two kinds of neoadjuvant chemoradiotherapy（NCR） in advanced rectal cancer with total mesorectal excision role. Methods：Will be admitted 78 patients with T3, T4 low rectal cancer were randomly divided into two groups of 39 cases. All given radiotherapy, each 2Gy, total dose of 45 - 50Gy, 5 times a week. A group supplemented by 5-fluorouracil （F-FU）, Leucovofin （LV）, B group supplemented by capecitabine （Xeloda） treatment. After 6 weeks of rest after radiotherapy, surgery. Surgery Junan total mesorectal excision operation specifications.Results：All patients completed the planned neoadjuvant chemotherapy, of which 11 tumors completely disappeared, no operation. Implementation of the 67 cases of radical resection, 65 cases of rectal surgery. 2 cases of abdominal perineal resection. Pathological results showed 10 cases of tumor disappeared （TO）. The total disappearance of the 21 cases cancer. T2NoI3 cases, T3No26 cases, T2-3NoI8 patients without T4 period. A total of 52 cases （66.67%） to fall on the （down staging）. All patients were followed from 6 to 42 months. No local recurrence, four cases of lung metastases, the total recurrence rate of 5.13%, no death, no relapse-free survival and survival rate were 94.87%.Conclusions：NCR and TME surgery practice for the effective combination to achieve the purpose of tumor downstaging, tumor regression, resectability and sphincter preservation rate was obviously increased, reducing the risk of recurrence.