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目的探讨贝伐单抗联合术前放化疗治疗局部进展期直肠癌的可行性。方法选择我院2011年3月~2013年3月经病理确诊为ⅢA、ⅢB期直肠癌患者40例,其中实验组(A组,21例)给予贝伐单抗两周期及卡培他滨单药(放疗日)加放疗,对照组(B组,19例)给予卡培他滨单药(放疗日)加放疗,两组均在新辅助治疗后4~8周行全直肠系膜切除术(total mesorectal excision,TME),术后常规给予4~6周期辅助化疗。主要研究终点为病理完全缓解(p CR)率、肿瘤降期、围手术期并发症及局部控制情况,次要终点为R0切除率、无病生存率(disease-free survival,DFS)及总生存率(overall survival,OS)。结果 A组患者的T分期、N分期、总降期率明显高于B组,差异均有统计学意义(P=0.036、0.045、0.044);而两组患者局部复发、p CR、R0切除率、围手术期并发症、2年DFS及OS差异无统计学意义。结论贝伐单抗联合术前放化疗治疗局部进展期直肠癌安全有效,显示出较好的肿瘤降期和可控的毒副作用且可能改善肿瘤的长期结局。
Objective To investigate the feasibility of bevacizumab combined with preoperative chemoradiotherapy in the treatment of locally advanced rectal cancer. Methods Forty patients with stage ⅢA and ⅢB rectal cancer diagnosed by pathology were selected from March 2011 to March 2013 in our hospital. The experimental group (group A, n = 21) received bevacizumab two cycles and capecitabine monotherapy (Radiotherapy day) plus radiotherapy, the control group (group B, 19 cases) given capecitabine monotherapy (radiotherapy day) plus radiotherapy, two groups were 4 to 8 weeks after neoadjuvant therapy, total mesorectal excision , TME), given routine postoperative 4 to 6 cycles of adjuvant chemotherapy. The primary endpoint was pathologic complete remission (pCR) rate, tumor regression, perioperative complications, and local control. The secondary endpoints were R0 resection, disease-free survival (DFS), and overall survival Overall survival (OS). Results The T stage, N stage and total reduction rate in group A were significantly higher than those in group B (P = 0.036, 0.045, 0.044). However, the local recurrence, p CR, R0 resection rate , Perioperative complications, 2-year DFS and OS no significant difference. Conclusion Bevacizumab combined with preoperative chemoradiotherapy is safe and effective in the treatment of locally advanced rectal cancer. It shows good tumor expiration and controlled side effects and may improve long-term tumor outcome.