局部晚期直肠癌术前同步放化疗临床意义的初步探讨

Management of locally advanced rectal cancer with preoperative three-dimensional conformal radiotherapy combined with chemotherapy

目的:评价术前FOLFOX4方案同步放射治疗局部晚期直肠癌的临床疗效和不良反应。方法:回顾性分析38例局部晚期直肠癌患者(cTNMⅡ期和Ⅲ期)的临床资料,患者均接受FOLFOX4方案(奥沙利铂+亚叶酸钙+5-氟尿嘧啶)化疗同步三维适形放疗,放疗采用6/15MV X射线对肿瘤局部照射,1.8～2.0Gy/次,总剂量45～50.4Gy。放疗结束后4～6周接受手术治疗。结果:新辅助放化疗的不良反应较小,主要是白细胞下降、手足麻木、恶心、呕吐及放射性直肠炎,全部患者均完成了治疗,其中31例(82%)施行了保肛手术,7例施行了Miles手术。术前肿瘤分期明显降低,新辅助治疗后原诊断为T3期的30例患者中5例降为T1期,11例降为T2期,其侵犯淋巴结均有缩小,其中10例转阴。原诊断为T4期的8例患者中1例降为T1期,2例降为T2期,3例降为T3期,其侵犯淋巴结也均有不同程度缩小,其中4例转阴。手术后病理判断CR 5例(13%),局部区域淋巴结阴性27例(71%)。结论:术前三维适形放疗同步FOL-FOX4方案化疗治疗局部晚期进展期直肠癌,能降低肿瘤临床分期,提高根治性切除率和保肛成功率,毒副作用小,是局部晚期直肠癌综合治疗的一种有效方法。

OBJECTIVE： To evaluate the efficacy and toxicity of neoadjuvant three-dimensional eonformal radiothera- py combined with FOLFOX4 regimen in the management of locally advanced rectal cancer. METHODS： Thirty-eight pa- tients with TNM II or TNM l]] locally advanced rectal cancer received FOLFOX4 regimen （oxaliplatin＋ CF＋ 5-FU） combined with radiotherapy to pelvis, 1. 8--2 Gy daily up to 45- 50. 4 Gy. Surgical operations were performed 4- 6 weeks after neoadjuvant therapy. RESULTS： The adverse effects were minor. The main side effects were neutropenia, hand and foot numbness,nausea,vomiting and radiation proctitis,and no patients quit because of the side effects. The rate of sphincter preservation was 82 %（31/38）. Tumor stages were downstaged significantly. Five patients in 30 cases whose original diagnosis for T3 downstaged to T1 stage, 11 patients downstaged to T2 stage and the lymph nodes involved re- duced,including 10 cases turned to negative. Down-staging occurred in 8 cases whose original diagnosis for T4. One case downstaged to T1 stage,2 cases downstaged to T2 stage,3 cases downstaged to T3 stage,and the lymph nodes involved re- duced, including 4 cases turn negative. There was 5 （13 % ） patients being assessed pathologic complete response and nod- al negativity was 71% （27/38） postoperation. CONCLUSIONS： Neoadjuvant therapy of three-dimensional conformal ra- diotherapy combined with FOLFOX4 regimen shows high efficacy in tumor down-staging and shrinkage of tumor volume, and improves the resection rate and sphincter preservation. It can be considered as one of the effective and safe treatment for advanced lower rectal cancer.