论文部分内容阅读
目的探讨将新辅助化放疗与全直肠系膜切除(TME)操作规范相结合能否进一步提高局部进展期低位直肠癌的治疗效果。方法2001年5月至2004年6月,将60例T3、T4期的低位直肠癌随机分为二组,给予放疗40～46Gy/20～23次,每周5次,每次2Gy。A组同时给予卡培他滨2500mg/(m2·d),分2次口服,服用14d休息7d;B组给予卡培他滨1250mg/(m2·d),分2次口服,从放疗开始连续服用至手术,放疗结束后休息6周进行手术。手术均按TME操作规范进行。结果全部病例按计划完成新辅助化放疗,其中9例肿瘤完全消失,未行手术。51例施行了根治性切除术,49例为保肛手术,2例为腹会阴切除术,故全组实际保留肛门率为96.67%(58/60)。病理结果显示8例肿瘤消失(T0)。总的肿瘤消失为17例,T2N011例,T3N019例,T2-3N113例,无T4期。总共43例(71.67%)达到降期(downstaging)。全组均获随访,随访时间6～38个月,中位24个月。随访中无局部复发,2例肺转移,总复发率3.33%,无死亡,无瘤生存和无复发生存率均为96.67%。新辅助化放疗的副反应发生率为28.67%,2例Ⅲ级均发生在手足综合征。结论新辅助治疗与TME操作规范相结合有效地达到肿瘤降期的目的,肿瘤缩小,切除率和肿瘤保肛率均明显增加,进一步降低了复发的风险,提高了长期生存的希望;副反应轻、安全、病人耐受好。
Objective To explore whether the combination of neoadjuvant chemoradiotherapy and total mesorectal excision (TME) can further improve the therapeutic effect of locally advanced low rectal cancer. Methods From May 2001 to June 2004, 60 patients with T3 and T4 low rectal cancer were randomly divided into two groups. Radiotherapy was given 40 to 46 Gy / 20 to 23 times a week for 5 times a week for 2 Gy. Group A was given capecitabine 2500mg / (m2 · d) at the same time, divided into 2 times orally and taken for 14 days and rest for 7 days. Group B was given capecitabine 1250mg / (m2 · d) orally twice daily after radiotherapy Take to surgery, 6 weeks after the end of radiotherapy for surgery. Surgery according to TME operating rules. Results All cases were completed neoadjuvant radiotherapy according to plan, of which 9 cases disappeared completely without surgery. Fifty-one patients underwent radical resection, 49 underwent anal sphincter preservation and 2 underwent perineal resection. Therefore, the anus retention rate in the whole group was 96.67% (58/60). Pathological results showed that 8 cases of tumor disappeared (T0). The total tumor disappeared in 17 cases, T2N011 cases, T3N019 cases, T2-3N113 cases, no T4 period. A total of 43 patients (71.67%) reached downstaging. All patients were followed up for 6 to 38 months with a median of 24 months. No local recurrence followed up, 2 cases of lung metastasis, the total recurrence rate was 3.33%, no death, no tumor-free survival and no recurrence survival rates were 96.67%. The incidence of side effects of neoadjuvant radiotherapy was 28.67%, and 2 cases of grade Ⅲ occurred in hand-foot syndrome. Conclusion The combination of neoadjuvant therapy and TME can effectively reduce the tumor. The tumor shrinkage, resection rate and anal sphincter preservation rate are significantly increased, which further reduces the risk of recurrence and enhances the hope of long-term survival. The side reaction is mild , Safe, patient well tolerated.