伊立替康、5氟尿嘧啶及联合短程放射治疗后直肠癌的组织病理学变化

Pathological changes of rectal cancer after irinotecan, 5-fluorouracil or combined short-term radiotherapy

目的观察并评价低位直肠癌术前伊立替康（CPT-11）、5氟尿嘧啶（5-FU）及联合短程放射治疗后的病理学改变及疗效，为寻找有效的新辅助治疗方案提供理论依据。方法2002年4月至2009年4月山西省肿瘤医院41例低位直肠癌患者在术前行CPT-11、5-FU及联合短程放射治疗。伊立替康组18例，伊立替康联合短程放疗组23例。观察两组患者治疗前后的病理改变，比较两种治疗方法的差异。结果两组患者在显微镜下均出现不同程度的肿瘤细胞变性、坏死；CT显示伊立替康组肿瘤与治疗前相比平均缩小33．1％（直径13．5mm比20．2mm），伊立替康联合短程放疗组肿瘤平均缩小34．4％（直径12．8mm比19．5mm）。按直肠癌消退分级（RCRG）伊立替康组和伊立替康联合短程放疗组的例数分别为：1级7例和18例，2级4例和3例，3级7例和2例（均P〈0．05）。两组3级癌细胞死亡、间质纤维化、血管内膜增厚的比例分别为：7例和17例，6例和17例，3例和14例（均P〈0．05）。伊立替康联合短程放疗组中有5例患者达到了病理学完全缓解。结论CPT-11、5-FU可以作为直肠癌的新辅助治疗药物，两种药物结合短程放射治疗疗效更好。

Objective To observe and evaluate the pathologic changes and curative effects of irinotecan （CPT-11）, 5-fluorouracil （5-FU） and combined short-term radiotherapy before low-set rectal cancer operation so as to provide a theoretic basis for formulating a new effective adjuvant therapeutic regimen. Methods A total of 41 patients of low rectal cancer were treated with CPT-11, 5-FU therapy or CPT-11 plus 5-FU combined short-term radiotherapy from April 2002 to April 2009. They were divided into 2 groups according to different treatment schemes, including irinotecan group （n = 18 ） and irinotecan combined short-term radiotherapy group （ n = 23 ）. The pathologic changes before and after treatment were observed and the differences of two treatment approaches compared. Results Tumor cells had different degrees of degeneration and necrosis under microscope in two groups. Compared with computed tomographic findings before therapy, tumor sizes of two groups were reduced by an average of 33.1% （ 13.5 mm vs 20.2 ram） and 34. 4% （ 12. 8 mm vs 19.5 ram） respectively. Two groups were graded according to the RCRG （rectal cancer regression grade）score： RCRGI： 7 cases vs 18 cases, RCRG2：4 cases vs 3 cases and RCRG3：7 cases vs 2 cases. According to the pathologic evaluation standard, 3-degree necrosis, cell interstitial fibrosis and intimal thickening in vessels were observed in two groups： 7 cases vs 17 cases, 6 cases vs 17 cases and 3 cases vs 14 cases respectively （ all P 〈 0. 05 ）. Five patients achieved complete pathological remission in the irinotecan combined short-term radiotherapy group. Conclusion Based on the pathological changes and mitigation results after treatment, CPT-11 and 5-FU may be used as neoadjuvant drugs for rectal cancer. If the above two drugs can be used in combination with short-term radiation, the curative effect will be better.