局部中晚期中低位直肠癌术前放疗效果观察

Observation on the effect of preoperative radiotherapy on the local advanced middle and low rectal cancer

目的 探讨局部中晚期直肠癌术前长疗程放化疗与短疗程放疗的疗效及患者不良反应。方法 回顾性分析2004年4月至2010年4月收治的64例局部中晚期中低位直肠癌患者临床资料。其中40例接受术前长疗程同步放化疗，DT 45～50 Gy／25次，1.8～2.0 Gy／次，5次／周，同步卡培他滨化疗1 650 mg／m^2，2次／d，第1天至第14天，第21天至第35天，放疗结束后4～6周进行手术；24例接受术前短疗程放疗，DT 25 Gy／5次，5 Gy／次，5次／周，放疗结束后2周内进行手术。结果 长疗程放化疗组的根治性切除率及保肛率分别为85.0 %（34／40）、65.0 %（26／40），优于短疗程放疗组的58.3 %（14／24）、33.3 %（8／24），两组差异有统计学意义（χ^2＝5.689，P＝0.019；χ^2＝6.040，P＝0.041）。两组的各项缓解率、放射损伤、手术并发症及1、3、5年总生存期方面差异均无统计学意义（均P＞0.05）。结论 两种术前放疗方式治疗局部中晚期中低位直肠癌的缓解率和总生存期无明显差异，但术前长疗程放化疗有可能提高保肛率及根治性切除率，且不增加放射损伤及手术并发症。

Objective To discuss the treatment efficacy and radiotherapy side effects of the preoperative long-course radiochemotherapy and preoperative short-course radiotherapy. Methods 64 patients with local advanced middle and low rectal cancer who got the treatment from April 2004 to April 2010 were analyzed retrospectively. 40 patients got the preoperative long-course radiochemotherapy under the dose of DT 45-50 Gy/25 F, 1.8-2.0 Gy/F, 5 F/W, combining with the synchronous capecitabine chemotherapy （1 650 mg/m^2, 2 F/d, d1-14/d21-35）, and accepted operation 4-6 weeks after the radiotherapy. The rest 24 patients underwent the preoperative short-course radiotherapy under the dose of DT 25 Gy/5 F, 5 Gy/F, 5 F/W, and got the operation in 2 weeks after the radiotherapy. Results The radical and anus reservation rates in preoperative long-course radiochemotherapy group [85.0 % （34/40）, 65.0 % （26/40）] were higher than those in preoperative short-course radiotherapy group [58.3 % （14/24）, 33.3 % （8/24）] （χ^2 = 5.689, P = 0.019; χ^2 = 6.040, P = 0.041）. There were no significant differences between the two groups on the index of remission rates, radiation injury, surgical complications, and overall survival rate of 1, 3, 5 years （all P 〉 0.05）. Conclusions The remission rate and overall survival time between the preoperative long-course radiochemotherapy group and preoperative short-course radiotherapy have no significant difference. But the preoperative long-course radiochemotherapy may improve the anus reservation rate and the radical resection rate, without increasing the radiation injury and surgical complications.