低位直肠癌术前同步放化疗的远期疗效及安全性研究

Long-term Efficacy and Safety of Preoperative Chemoradiotherapy for Low Rectal Cancer

目的评估术前口服卡培他滨(希罗达)与放疗联合治疗局部进展期低位直肠癌的远期疗效及安全性。方法对局部进展期(T3/T4)低位直肠腺癌(距肛缘≤9 cm)患者51例,术前给予口服卡培他滨(希罗达)并联合放疗。放疗结束后休息3～4周,按TME原则进行手术。结果 3例患者临床完全消退(cCR),占5.88%,未行手术;其余48例患者均行根治性切除术(RO),实际保肛率90.20%(46/51),10例术后病理检查未见肿瘤细胞,为病理消退(pCR),总消退率为25.49%(13/51)。肿瘤降期41例,占80.39%。5年无病生存率为70.59%,总生存率为80.39%。放化疗过程中出现3、4级不良反应5例,无疾病进展、手术死亡者。结论术前口服卡培他滨联合放疗治疗局部进展期低位直肠癌是有效安全的。

Objective To evaluate the efficacy and safety of preoperative concurrent oral capecitabine and radiotherapy for locally advanced low rectal cancer. Methods 51 patients with locally advanced T3/T4 low rectal tumors（ anal verge≤9 cm） received concomitant oral capecitabine and radiotherapy before surgery, and was given total mesorectal excision（TME） 3-4 weeks after radiotherapy. Results 3 cases had no surgery because of clinical complete regression ,48 cases had radical surgery. The rate of sphincter preservation was 90.20% （46/51） actually. 10 cases had no tumor ceils in pathology which were pathological complete regression,complete regression rate was 25.49% （ 13/51 ） ,and tumor down staging accounted for 80.39% （41/51）. 5-year disease free survival rate was 70.59% ,5-year survival rate was 80.39%. 5 cases had 3,4 grade side effects during preoperative chemoradiotherapy,all patients had no progression of disease and decease in surgery. Conclusion Preoperative concurrent oral capecitabine and radiotherapy in treatment of local advanced low rectal cancer is effective and safe.