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目的:探讨局部晚期直肠癌术前同期放化疗后临床及病理降期情况及其相关影响因素。方法:回顾性分析30例行术前同期放化疗的局部晚期直肠癌患者的临床资料,放疗采取三维适形放疗技术,同期化疗为奥沙利铂与卡培他滨联合方案。评价其术前临床及术后病理降期效果并分析相关影响因素。结果:术前临床评价T分期降期率达73.3%(22/30),17例N+患者10例淋巴结完全消退;术后病理发现,14例患者T分期下降,降期率为46.7%,其中5例患者达pCR,完全缓解率为16.7%(5/30)。单因素分析显示,放疗后继续服用卡培他滨及放疗至手术间歇期长者肿瘤降期率高。除1例放疗期间出现膀胱瘘者,仅1例出现Ⅲ级造血系统毒副反应,未见Ⅳ级毒副反应。结论:局部晚期直肠癌术前同期放化疗耐受性良好,有效率高,更加合理的同期化疗需更进一步的临床试验证实。
Objective: To investigate the clinical and pathological degeneration and related factors after preoperative radiotherapy and chemotherapy in locally advanced rectal cancer. Methods: The clinical data of 30 patients with locally advanced rectal cancer treated with chemoradiotherapy during the same period before surgery were retrospectively analyzed. The three-dimensional conformal radiotherapy was used for radiotherapy. The concurrent chemotherapy was oxaliplatin combined with capecitabine. Evaluate its preoperative clinical and postoperative pathological decline effect and analyze the related factors. Results: Preoperative clinical evaluation of T stage down rate of 73.3% (22/30), 17 cases of N + patients with 10 cases of complete regression of lymph nodes; pathological findings, 14 patients with T staging decreased, the down rate was 46.7% Five patients achieved pCR, with a complete remission rate of 16.7% (5/30). Univariate analysis showed that after the radiotherapy continue to take capecitabine and radiotherapy to intermittent surgery in elderly patients with high rates of decline. In addition to a case of bladder fistula during radiotherapy, only 1 case of grade Ⅲ hematopoietic toxicity, no grade Ⅳ toxicity. Conclusion: Chemotherapy in locally advanced rectal cancer is well tolerated and effective in preoperative period, and more reasonable concurrent chemotherapy should be confirmed by further clinical trials.