摘要
目的 探讨新辅助放化疗联合手术治疗局部进展期（CtnmⅡ期和Ⅲ期）低位直肠癌的疗效.方法 回顾分析我院281例局部进展期低位直肠癌患者（肿瘤距离肛缘≤6cm）临床资料,所有患者全部进行术前联合放化疗,给予盆腔常规放疗,总剂量为45～50Gy,2Gy/d,每周5天,休息2d.同时给予口服卡培他滨1250mg/（m^2·d）,分2次口服,直至手术;放疗结束后休息4～6周,按TME原则行根治性切除术.结果 所有患者均完成新辅助放化疗,急性毒副反应较小,一般为Ⅰ～Ⅱ级反应.其中15例（5.3%）复查肿瘤完全消失,未行手术治疗并予以密切随访.266例按照TME原则行直肠癌根治性切除术.241例行保肛手术（保肛率90.6%）.手术标本显示肿瘤已完全消失24例,肿瘤降期明显.局部复发率显著降低（3.9%）.结论 新辅助放化疗对局部进展期低位直肠癌患者肿瘤降期作用明显,提高保肛成功率,降低局部复发率,是局部进展期低位直肠癌综合治疗的一种安全有效的治疗方案.
Objective To evaluate the clinical efficacy of neoadjuvant chemoradiotherapy （NCR） combined with surgery in patients with locally advanced low rectal cancer（LALRC）. Methods Between January 2005 and June 2010,281 patients with TNM Ⅱ or TNM Ⅲ LALRC（ distance from the tumor to the anal verge ≤6 cm）were treated by preoperative radiotherapy to the pelvis （2.0 Gy daily up to a total of 45-50 Gy in 4 - 5 weeks） ,concomitantly with oral capecitabine（CAP） 1250 mg/m^2 daily divided into 2 do-ses, continuously for 10 weeks up to the time of surgery. Surgical operations were performed 4 - 6 weeks af-ter completion of NCR. In all the patients, surgery was carried out according to the principle of total meso-rectal excision（TME）. Results The acute toxic and adverse effects were few. The tumor disappeared completely in 15 patients （5.3%）who were not operated upon thereafter. A total of 266 patients（94.7% ） were operated on according to the principle of TME. The rate of sphincter preservation was 90.6% （241/ 266）. As a result of examination of the surgical specimens, 24 patients had a complete pathologic re-sponse, bringing to a total of 39 patients （ 13.9% ） acquiring a complete clinical response, down - staging was obtained. The local recurrence rate was only 3.9%. Conclusion In the treatment of LALRC, NCR shows high efficacy in tumor down - staging, improves sphincter preservation and decreases local recur-rence rate. It can be considered as a safe and effective therapy for LALRC.
出处
《临床外科杂志》
2012年第4期234-236,共3页
Journal of Clinical Surgery
关键词
局部进展期低位直肠癌
新辅助放化疗
保肛手术
locally advanced low rectal cancer
neoadjuvant chemoradiotherapy
sphinctersaving resection
