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目的探讨新辅助放化疗联合保肛手术治疗局部进展期直肠癌的安全性。方法回顾性分析2007年6月至2009年6月期间我科收治的34例T3、T4期低位直肠癌采用新辅助放化疗联合保肛手术治疗患者的临床资料。常规分割放疗,总剂量40Gy,每周5次,每次2Gy。于第4周放疗结束后开始行全身化疗,1个疗程,方案为奥沙利铂(150mg/d1)、亚叶酸钙(100mg/d1～3)加5-FU(750mg/d1～3)。于新辅助治疗结束后4周进行手术。结果经新辅助治疗后,肿瘤直径平均缩小41.2%,67.6%(23/34)的病例T分期下降,淋巴结阴转率为58.8%(10/17)。术后无吻合口漏发生,发生肝转移1例,局部复发1例;88.2%(30/34)患者术后肛门功能良好。结论对局部进展期直肠癌患者采用新辅助放化疗,能使肿瘤分期降低;联合行保肛手术,不增加手术并发症的发生率,安全、有效。
Objective To investigate the safety of neoadjuvant chemoradiation combined with anal sphincter preservation in the treatment of locally advanced rectal cancer. Methods The clinical data of 34 patients with T3 and T4 low rectal cancer treated with neoadjuvant chemoradiation and anus preservation operation in our department from June 2007 to June 2009 were retrospectively analyzed. Conventional radiotherapy, the total dose of 40Gy, 5 times a week, each 2Gy. At the end of Week 4, systemic chemotherapy was started after radiotherapy. One course of treatment was oxaliplatin (150 mg / d1), leucovorin (100 mg / d1-3) plus 5-FU (750 mg / d1-3). Surgical procedures were performed 4 weeks after neoadjuvant treatment. Results After neoadjuvant therapy, the average diameter of tumor was reduced by 41.2%. The T stage of 67.6% (23/34) cases decreased, and the negative conversion rate of lymph nodes was 58.8% (10/17). No postoperative anastomotic leakage occurred, with liver metastases in 1 case and local recurrence in 1 case. 88.2% (30/34) patients had good anus after operation. Conclusions Neoadjuvant chemoradiotherapy is used in patients with locally advanced rectal cancer, which can reduce the tumor staging. Combined with anal sphincter preserving surgery can not increase the incidence of surgical complications, which is safe and effective.