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[目的]探讨局部晚期中低位直肠癌新辅助同步放化疗的疗效及其影响因素。[方法]58例局部晚期(T3～4N0～1M0)中低位直肠癌术前接受同步放化疗,放疗剂量50Gy,化疗包括奥沙利铂+卡培他滨的联合化疗组及不含铂类药物的单药化疗组。共55例患者同步放化疗结束后2～10周内完成根治性手术,依据术后病理结果进行疗效评价。[结果]全组55例患者手术顺利,无严重手术并发症;术后病理示肿瘤完全消退8例(14.5%),重度消退11例(20.0%),中度消退20例(36.4%),轻度及无消退16例(29.1%);治疗前肿瘤(T)及淋巴结(N)临床分期与放化疗后肿瘤消退程度无关;奥沙利铂联合卡培他滨化疗组肿瘤完全消退与重度消退率为41.2%,不含铂类药物组为23.8%(P>0.05);与术前临床分期相比,同步放化疗后原发肿瘤(T)降期率为41.8%,淋巴结(N)降期率为58.8%。[结论]新辅助同步放化疗用于局部晚期中低位直肠癌的术前治疗可使大部分肿瘤获得不同程度消退;有关直肠癌同步放化疗疗效的预测指标以及高效的化疗方案有待进一步深入研究。
[Objective] To investigate the efficacy and influencing factors of neoadjuvant chemoradiotherapy in locally advanced low or middle rectal cancer. [Method] 58 cases of locally advanced (T3 ~ 4N0 ~ 1M0) low and middle rectal cancer received concurrent chemoradiotherapy before radiotherapy, the dose of 50Gy, chemotherapy including oxaliplatin + capecitabine combination chemotherapy group and non-platinum drugs Single-agent chemotherapy group. A total of 55 patients completed radical surgery within 2 to 10 weeks after the end of concurrent chemoradiotherapy, and the curative effect was evaluated according to the postoperative pathological results. [Results] All the 55 patients underwent surgery successfully with no serious complications. Pathological examination revealed complete regression of tumor in 8 cases (14.5%), severe subsidence in 11 cases (20.0%), moderate subsidence in 20 cases (36.4%), There were 16 cases (29.1%) with mild and without remission. The clinical stage of tumor (T) and lymph node (N) before treatment was not related to the degree of tumor regression after radiotherapy and chemotherapy. The tumor regression and severity of oxaliplatin combined with capecitabine chemotherapy (P <0.05). Compared with the preoperative clinical stage, the rate of down conversion of primary tumor (T) was 41.8% and lymph node (N) The due date rate is 58.8%. [Conclusion] Neoadjuvant chemoradiotherapy for the treatment of locally advanced low-grade rectal cancer can make most of the tumors subside to varying degrees. The predictive value of concurrent chemoradiation and high-efficiency chemotherapy remains to be further studied.