局部晚期低位直肠癌术前放化疗的降期效果和加前切除的远期疗效  

Down stage and long term results of preoperative chemoradiotherapy for locally advanced lower rectal cancer: a cooperative clinical trial of 6 institutions

作　　者：刘建东[1] 杜同海[2] 才又红[3] 王琦[4] 曹修德 郭学恒 

机构地区：[1]北京市普仁医院(原北京市第四医院)外科,100062 [2]河北邯郸铁路医院外科 [3]河北省邯郸市第一医院外科 [4]北京市普仁医院(原北京市第四医院)放疗科,100062 [5]河北省永年县医院大北旺分院外科 [6]河北省邯郸县第二医院外科

出　　处：《中华放射肿瘤学杂志》2005年第4期298-301,共4页Chinese Journal of Radiation Oncology

摘　　要：目的探讨局部晚期低位直肠癌术前放化疗的降期效果和加前切除与Miles手术的远期疗效的比较。方法将103例直肠癌患者分为术前放化疗+前切除组(A组,53例)和Miles手术组(B组,50例)。原发肿瘤距肛门中位距离6.2cm。临床分期Ⅱ期22例,Ⅲ期81例(TNM,UICC)。放疗采用直线加速器盆腔3～4个野照射,剂量35～45Gy,4～5周完成。化疗以氟尿嘧啶为主联合化疗。结果A、B组5年生存率分别为64.2%、43.7%(P<0.05),5年无瘤生存率分别为52.8%、31.6%(P<0.05),局部复发率分别为15.2%、19.3%(P>0.05),远处转移率分别为25.5%、48.5%(含局部复发加远处转移)(P<0.05)。A组术后病理学完全缓解率为13.2%。随访率为88.3%。结论术前放疗和化疗加前切除手术治疗局部晚期低位直肠癌的方法不但能够保肛,而且可改善5年生存率和无瘤生存率。Objective To investigate the down stage effect and long-term results of preoperative chemoradiotherapy for locally advanced lower rectal adenocarcinoma. Methods From Jan. 1989 to Jul 1999, 103 patients suffering from lower rectal carcinoma were treated. Criteria entry: 1. Distance between anal verge and centre of tumor 4-8?cm(median 6.2?cm), 2. Uncertainty in decision of preservation of anus before admission, 3. Lesion belonged to locally advanced type, 4. definitive pathology, clinical stage and presence of objective observation of tumor extent, 5. Performance status proposed by Eastern Cooperative Oncology Group 0-2, 6. Age< 75years, 7. Normal blood, heart, renal function and 8. absence of previous anti-cancer therapy. Pathology: tubular adenocarcinoma 69, papillary adenocarcinoma 21, mucinous adenocarcinoma10 and signet-ring cell carcinoma 3. Clinical stage: with the present auxillary examinations, there were TNM stage Ⅱ 22 and stage Ⅲ 81. Decision of treatment: This series of patients was assigned rather than randomized. 53 patients were treated by preoperative chemoradiotherapy(Group A) and 50 patients received Mile's operation (Group B). Preoperative radiotherapy-linear accelerator 6-8?MV X-ray, 35-45?Gy/4-5 wk interposed with chemotherapy; preoperative chemotherapy—5-Fu based chemotherapy (5-Fu 300-400?mg/m2, calcium folinate 200?mg/session, iv, totally 5day). Operation was done 29-58 days(median 38days) after completion of chemoradiotherapy. Surgery: 53 patients received the anal preserving operation of anterior resection; 50 patients were treated by Mile's operation. Postoperation chemotherapy-a total of 34 patients received postoperative chemotherapy and/or radiotherapy for liver or bony metastasis. 88.3% of patients had complete data of follow-up. Results The 5-year survival rate, disease-free survival rate for group A and group B were 64.2% and 43.7%, 52.8% and 31.6% , respectively,(P<0.05). The local failure rate , distant metastasis rate of group A and group B was 15.2% and 19.3% (P>0.05), 25.

关 键 词：局部晚期 低位直肠癌 术前放疗 化疗 降期 切除手术 肿瘤 消化系统 外科学 

分 类 号：R735.37[医药卫生—肿瘤] R730.53[医药卫生—临床医学]