直肠癌术前热疗、放疗及化疗的临床病理意义

Clinical and histopathological characteristics of the response of rectal carcinoma to combined preoperative thermoradiochmotherapy

目的 探讨直肠癌手术前热疗、放疗及化疗后临床病理特征。方法 38例局部进展期直肠癌病例进行了手术前热疗、放疗及化疗。局部热疗采用SIGMA60热疗机 (BSD - 2 0 0 0 ) ,放疗总剂量为 45Gy。四氢叶酸 +5 -FU全身化疗共 2个疗程。辅助治疗完成后 4～ 6周手术。结果 经过术前辅助治疗 ,肿瘤的直径平均缩小 35 .5 %。 4例 (1 0 .5 % )达到病理完全缓解 ,另外 2 7例 (71 .0 % )达到PR(癌细胞坏死率≥ 50 % ) ,总有效率达 81 .6 %。辅助治疗后淋巴结阳性率由 68.4 %降至 44 .7%。病理检查所有肿瘤均有不同程度的癌细胞变性、细胞结构破坏、肿瘤血管破坏、出血及大片凝固性坏死。瘢痕区域可见灶性钙化、再生上皮。结论 术前热疗、放疗及化疗可以使部分肿瘤获得病理完全缓解、缩小原发瘤。

Objective To assess the clinical and histopathological characteristic of the response preoperative regional hyperthermia,radiation and systematic chemotherapy in the management of locally advanced rectal cancer. Methods 38 cases of locally advanced adenocarcinoma of the rectum eatered this study. Hyperthermia using the SIGMA 60 applicator (BSD 2000) was given once a week before radiotherapy which was delivered with a total dose of 45 Gy. Chemotherapy was administrated in two cycles with folinic acid and 5 FU. Surgery followed 4 to 6 weeks after preoperative treatment. Results Tumor lesions shrinked 35.5% in diameter in average. 4 of the patients(10.5%) had a complete pathological response and 27patients(71%) had a partial pathological response (pathological response rate≥50%). The percentage of lymph node metastasis in all cases was decreased from 68.4% to 44.7% . Conclusion A complete or partial pathological response, shrinkage of the primary tumors and decrease of the lymph node metastasis and down-stage of the tumors were observed after preoperative treatment.