新辅助放化疗对局部进展期直肠癌近期疗效的影响

Short-term efficacy of neoadjuvant chemoradiotherapy in treatment of locally advanced rectal cancer

目的探讨术前新辅助放化疗（NCRT）对低位局部进展期直肠癌围手术期及近期疗效的影响。方法回顾性分析138例低位局部进展期直肠癌患者的临床资料,分为NCRT组和直接手术治疗组各69例,观察NCRT组的毒副反应、治疗效果,比较两组在围手术期并发症发生情况。结果 NRCT组的急性毒副反应较小,主要为Ⅰ~Ⅱ度,如乏力、放射性皮炎、骨髓抑制、胃肠反应、泌尿系急性毒性反应等,有5例患者出现Ⅲ度反应。NRCT组患者降期39例（56.52%）,术后证实为病理完全缓解者14例（20.29%）,其手术保肛率为55.07%,明显高于直接手术组的36.23%（χ2=4.94,P〈0.05）。NRCT组术中出血量较直接手术组少,差异有统计学意义（χ2=5.71,P〈0.05）,但围手术期并发症发生率比较均无明显差异（P〉0.05）。结论 NCRT的毒副反应较轻,可明显降低局部进展期直肠癌的病理分期,提高保肛率,同时并不增加术后并发症。

Objective To evaluate the short-term efficacy of neoadjuvant chemoradiotherapy（NCRT） in treatment of locally advanced rectal cancer. Methods The clinical data of 138 patients with locally advanced rectal cancer was analyzed retrospectively. They were divided into NRCT group which underwent preoperative NCRT and control group which received operation when diagnosed. The adverse effects of NRCT group were observed and the perioperative complications between two groups were compared. Results The acute adverse effects of NRCT group were slight and mainly appeared Grade Ⅰ~Ⅱsuch as fatigue, radiation dermatitis, bone marrow suppression, gastrointestinal and urinary reactions, only 5 patients occurred the adverse effects of Grade Ⅲ. The down-staging rate of NRCT group was 56.52%, 14 patients（20.29%）achieved pathological complete remission. The sphincter preservation rate was 55.07% in NCRT group which was obviously higher than the 36.23% in the control group（χ2=4.94,P〈0.05） while the intraoperative blood loss was significantly less than control group（χ2=5.71,P〈0.05）.The incidence of complications between two groups was not statistically different（P〈0.05）. Conclusion The acute adverse effects of NRCT group are slight. It can obviously reduces the pathological staging of locally advanced rectal cancer and increases the sphincter preservation rate, while the postoperative complications do not increase.