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[目的]探讨中低位局部进展期直肠癌术前30Gy/10f短程放疗的治疗效果及预后因素分析。[方法]中低位局部进展期直肠癌患者282例。总剂量30Gy,分10次照射的术前短程放疗方案(30Gy/10f),生物有效剂量为36Gy,照射方式为3D适形放疗。放疗后休息2~4周后行手术治疗。分析相关临床病理学因素对预后的影响。[结果]病理完全缓解率(yp CR)为5.7%(16/282),术后病理降期率35.8%(101/282)。3年无病生存率为78.0%,局部复发率4.6%(13/282)。发生转移50例,无转移生存率82.3%。同时合并转移、复发1例。多因素分析表明:肿瘤分化程度、yp N分期、手术方式是影响3年无病生存率的独立因素。环周切缘状态和yp N分期是影响局部复发的独立因素。[结论]中低位局部进展期直肠癌术前应用30Gy/10f短程放疗可以获得良好的局部控制,是一种有效的新辅助治疗方案。
[Objective] To investigate the treatment effect and prognostic factor of 30Gy / 10f short-term radiotherapy in moderate and low-grade locally advanced rectal cancer. [Methods] 282 patients with locally advanced rectal cancer in the middle and low stages. The total dose of 30Gy, divided 10 times irradiation preoperative short-range radiotherapy program (30Gy / 10f), the biological effective dose of 36Gy, irradiation mode for 3D conformal radiotherapy. Resting after radiotherapy 2 to 4 weeks after surgery. Analysis of the impact of relevant clinicopathological factors on prognosis. [Results] The pathologic complete response rate (yp CR) was 5.7% (16/282). The pathologic reduction rate was 35.8% (101/282). The 3-year disease-free survival rate was 78.0% and the local recurrence rate was 4.6% (13/282). Metastasis occurred in 50 cases, without metastasis survival rate of 82.3%. At the same time merger and metastasis, recurrence in 1 case. Multivariate analysis showed that the degree of tumor differentiation, yp N staging, and surgical approach were independent factors that affected the 3-year disease-free survival rate. Circumferential margin status and yp N staging are independent factors affecting local recurrence. [Conclusion] The preoperative application of 30Gy / 10f brachytherapy in locally advanced rectal cancer in middle and low grades can obtain good local control, which is an effective neoadjuvant treatment regimen.