术前同步放化疗联合新辅助化疗局部进展期直肠癌的疗效及患者耐受分析

Curative Effect of Preoperative Concurrent Chemoradiotherapy Combined with Neoadjuvant Chemotherapy in the Treatment of Locally Advanced Rectal Cancer and Patients’ Tolerance

目的探讨术前同步放化疗联合新辅助化疗治疗局部进展期直肠癌的临床疗效及安全性。方法以90例局部进展期直肠癌患者为对象,按照患者入院顺序编号分为对照组和观察组,各45例。对照组术前行同步放化疗,观察组术前实施同步放化疗联合新辅助化疗治疗,2组治疗结束后均行全直肠系膜切除术(TME)。比较2组临床疗效、药物安全性及手术并发症发生情况,并随访2组预后效果(局部复发率、临床转移率、术后2年总生存率)。结果观察组临床总有效率为69.77%,明显高于对照组43.18%(P<0.05)。观察组恶心呕吐、神经系统毒性、肝脏毒性、血小板计数下降、白细胞计数下降等不良反应发生率较对照组略低,但差异无统计学意义(P>0.05)。术后2组并发症发生率和术后2年局部复发率无明显差异(P>0.05);观察组术后2年临床转移率、术后2年总生存率较对照组明显低、高(P<0.05)。结论术前同步放化疗联合新辅助化疗治疗局部进展期直肠癌,可有效提高临床疗效并改善预后效果,且患者对不良反应可耐受,有一定临床推广优势。

Objective To investigate the clinical curative effect and safety of preoperative concurrent chemoradiotherapy combined with neoadjuvant chemotherapy in the treatment of locally advanced rectal cancer.Methods 90 patients with locally advanced rectal cancer were selected as the subjects.They were divided into the control group and the observation group,45 cases in each group.The control group was treated with concurrent chemoradiotherapy before operation while the observation group was treated with concurrent chemoradiotherapy combined with neoadjuvant chemotherapy before operation.All patients in the 2 groups were treated with total mesorectal excision(TME)after the treatment.The clinical curative effect,drug safety and operative complications were compared between the 2 groups.The prognosis(local recurrence rate,clinical metastasis rate,2-year overall survival rate)of the 2 groups was followed up.Results The total effective rate in the observation group was significantly higher than that of the control group(69.77%vs 43.18%)(P<0.05).The incidence rates of adverse reactions such as nausea and vomiting,neurotoxicity,liver toxicity,blood platelet count decline and white blood cell count decline in the observation group were slightly lower than those of the control group(P>0.05).There was no significant difference in the incidence of postoperative complications and the postoperative 2-year local recurrence rate between the 2 groups(P>0.05).The clinical metastasis rate and the postoperative 9-year total survival rate of the observation group were lower and higher than those of the control group(P<0.05).Conclusion The application of preoperative concurrent chemoradiotherapy combined with neoadjuvant chemotherapy for patients with locally advanced rectal cancer can effectively improve the clinical curative effect and the prognosis.Patients can tolerate the side and toxic effects.