同步新辅助放化疗联合全根治性切除治疗中低位局部进展期直肠癌的探索研究

Neoadjuvant Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in the Treatment of Locally Advanced Middle and Lower Rectal Cancer

目的：探讨同步新辅助放化疗联合全直肠系膜切除术（TME）治疗中低位局部进展期直肠癌的可行性及安全性。方法：选取2013年6月-2014年6月本院23例中低位局部进展期直肠癌患者,Ⅱ期（T3-4No Mo）11例,Ⅲ期（T1-4N1-2Mo）12例,均接受术前同步新辅助放化疗（术前放疗总剂量全盆腔DT 40-46Gy/20-23 Fx,瘤床区加量至50-56 Gy/25-28 Fx;化疗采用含希罗达方案2个周期）。同步新辅助放化疗结束后4-8周行手术治疗,遵循TME原则,并尽可能保肛。结果：22例患者均完成同步新辅助放化疗,放化疗期间3级毒副反应总发生率为27.3%,无4级毒副反应者。放化疗后CR 2例、PR 14例、SD 4例;16例（80%）患者的临床TNM分期下降。同步新辅助放化疗结束后4-8周,20例患者行根治性手术治疗,其中12例行低位或超低位前切除术（Dixon术）,7例行腹会阴联合切除术（Miles术）,1例行Hartmann手术,保肛率为60.0%（12/20）。无一例发生围手术期死亡,术后并发症的总发生率为20%（4/20）。结论：同步新辅助放化疗联合TME治疗中低位局部进展期直肠癌安全而有效,可以降低肿瘤分期、提高肿瘤切除率和保肛率,改善患者的生活质量。

Objective：To evaluate the efficacy and safety of neoadjuvant concurrent chemoradiotherapy combined with TME（tota I mesorecta I excision）for the treatment of locally advanced middle and lower rectal cancer.Method：23 patients with locally advanced middle and lower rectal cancer were recruited from June 2013 to June 2014,11 cases had stage Ⅱ（T3-4No Mo）and 12 cases had stage Ⅲ（T1-4 N1-2Mo）.All patients received neoadjuvant concurrent chemoradiotherapy（the total dose of preoperative radiotherapy was 40-56 Gy/25-28 Fx, whole pelvis caval and boom to 50-56Gy/25-28 Fx to the tumor bed; concurrently combined with two cycles of capecitabine-based regimen）.The surgical operation with TME was performed as possible 4-8 weeks after concurrent chemoradiotherapy.Result：22 patients completed the neoadjuvant concurrent chemoradiotherapy. The total rate of level 3 adverse reaction was 27.3%, no 4 adverse reaction. After radiation and chemotherapy, CR was 2 cases, PR in 14 cases, 4 cases of SD, 16 cases（80%） of clinical TNM staging were declined. 20 patients were given surgical operation, 12 patients received low/ultra-low anterior resection（Dixon）, 7 patients received abdominoperineal resection（Mlies）, and 1 case received Hartmann routine surgery after chemoradiotherapy for 4-8 weeks.The sphincter preservation rate was 60.0%（12/20）.No perioperative death was observed,and the overall incidence of complication was 20%（4/20）.Conclusion：Neoadjuvant concurrent chemoradiotherapy combined with TME for treatment of locally advanced middle and lower rectal cancer is effective and safe,which can reduce the tumor stage and increase the complete tumor resection and sphincter preservation rates, and can also improve the patients＇ quality of life.