术前放化疗结合全直肠系膜切除在低位进展期直肠癌治疗中的应用

Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer

目的分析术前放化疗结合全直肠系膜切除术(TME)治疗低位进展期直肠癌的疗效。方法回顾性分析笔者所在医院2009年1月至2011年12月期间行术前放化疗联合TME的31例低位进展期直肠癌患者的临床资料。放疗采用常规分割放疗,总剂量50 Gy/25 f;化疗采用mFOLFOX6或CapeOX方案。临床-病理对照记录疗效,并评价保肛患者的肛门功能。结果全部患者均接受TME手术治疗,手术并发症发生率为12.9%(4/31),死亡率为3.2%(1/31)。经术前放化疗,肿瘤直径平均缩小21.9%;48.4%(15/31)的患者出现T分期下降,阳性淋巴结患者比例由83.9%(26/31)降至38.7%(12/31),5例(16.1%)患者获得病理学完全缓解,总有效率达74.2%(23/31);Ⅲ～Ⅳ度不良反应发生率为6.5%(2/31),保肛患者肛门功能良好率达84.6%(22/26)。结论从本组有限的病例看,对低位进展期直肠癌采用术前放化疗结合TME手术能够达到部分肿瘤的病理学完全缓解,缩小原发肿瘤,降低局部淋巴结转移率,从而达到降低肿瘤分期、提高手术疗效的目的。

Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision（TME）in treatment for locally advanced lower rectal cancer.Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively.Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken.The efficacy was assessed by recording results of clinical and pathological examination.The function of sphincter was also recorded.Results All 31 patients underwent TME operation.The complication morbidity and mortality was 12.9%（4/31）and 3.2%（1/31）,respectively.As a result of the preoperative management,the tumor was reduced by an average of 21.9%,down-regulation of T stage was observed in 48.4%（15/31）patients,the frequency of lymph node metastasis decreased from 83.9%（26/31）to 38.7%（12/31）.Pathological complete response was observed in 5 patients（16.1%）and the total response rate was 74.2%（23/31）,grade 3/4 toxicity was occurred in 2（6.5%）patients.84.6%（22/26）of patients underwent sphincter preservation surgery reserved good function of sphincter.Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe,which can lead to pathological complete response,decrease the tumor stage and the rate of lymph node metastasis,and can also increase the efficacy of operation.