新辅助放化疗治疗低位进展期直肠癌的临床研究

The clinical study of neoadjuvant therapy in treatment for advanced lower rectal cancer

目的探讨术前辅助放化疗对低位进展期直肠癌治疗效果。方法 47例低位进展期直肠癌患者(cTNMⅡ期和Ⅲ期),进行术前联合放化疗。放疗每周5d,每次1.8～2Gy,总剂量45～60Gy。同时持续口服卡培他滨1250mg/m2化疗,休息4～8周进行手术。结果新辅助放化疗的急性毒副反应较小,一般为Ⅰ～Ⅱ度反应,全部患者均完成了治疗,其中施行了保肛手术44例(93.6%),Miles手术3例。肿瘤分期降低明显,术后局部复发率明显下降,仅为4.3%。结论新辅助放化疗能使低位进展期直肠癌肿瘤降期,提高根治性切除率和保肛成功率,降低局部复发率,是低位进展期直肠癌综合治疗的一种有效方法。

Objective To evaluate the efficacy of neoadjuvant chemoradiotherapy on locally advanced low rectal cancer. Methods Forty-seven patients with TNMⅡor TNMⅢ lower rectal cancer were first treated by preoperative radiotherapy to pelvis,1.8~2Gy daily up to 45~60Gy in 4~5 weeks concomitantly with oral administration of capecitabine at 1 250mg/m2 for 10 weeks.Surgical operations were performed 4~8 weeks after neoadjuvant therapy. Results The acute poison and adverse effects was little and no patient＇s therapy were discontinued because of the acute effects. Tumor stages were down staged.The rate of sphincter preservation was 93.6%（44/47）.The recurrence rate was only 4.3%. Conclusion Neoadjuvant therapy shows high efficacy in tumor down-staging and shrinkage of tumor mass,and improves the resection rate and sphincter preservation for advanced lower rectal cancer.