新辅助放化疗在局部进展期低位直肠癌中的疗效  

Efficacy of neoadjuvant radiochemotherapy in treatment of locally advanced low rectal cancer

作　　者：郁宝铭[1] 张敏[2] 吴唯勤[2] 陈利文[2] 傅骏[2] 费春松[2] 沈英[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,200025 [2]上海市第八人民医院结直肠外科

出　　处：《中华外科杂志》2007年第7期445-448,共4页Chinese Journal of Surgery

摘　　要：目的探讨新辅助放化疗对局部进展期低位直肠癌的治疗效果。方法 2001年5月至2005年8月共收治105例局部进展期(T3、T4期)低位直肠癌患者,术前给予中等剂量放疗40～46Gy,分次剂量2 Gy/d,每周5 d,共4～5周完成放疗;放疗开始同时给予卡培他滨1250mg·m^(-2)·d^(-1),分2次口服,持续服用至手术。放疗结束后休息6周进行手术,手术均按直肠系膜全切除操作规范进行。结果全组105例患者均按计划完成预定的放化疗。其中36例出现各种不良反应,但Ⅲ级不良反应仅见2例手足综合征。13例患者放化疗后经复查后提示肿瘤消失未行手术。其余92例患者则施行了根治性手术,其中低位前切除术71例,结肠肛管吻合术(Parks 术)17例,腹会阴切除术4例,全组总保肛率为96.2%。术后标本病理检查显示11例未见癌细胞及阳性淋巴结。肿瘤 TNM 分期为 T0N0者24例,T2N0者23例,T3N0者43例,T4N0者2例,T2N1者5例,T3N1者8例;按 Dworak 肿瘤消退分级,TGR0 5例,TGR1 29例,TGR2 47例,TGR3 24例。全组共有82例(78.1%)达到降期。全组无手术死亡,术后出现3例直肠阴道漏,2例吻合口漏。所有患者均获随访,随访时间为16～67个月。随访期间肺转移4例,肝转移2例,局部复发4例,其中3例死亡。全组病死率为2.9%,3年无瘤生存率为82.8%,3年总生存率为96.5%。结论新辅助放化疗可有效达到肿瘤降期的目的,提高了局部进展期低位直肠癌的根切率和保肛率,进一步降低了局部复发率和总复发率,并明显提高了无瘤生存率和总生存率。Objective To explore efficacy of neoadjuvant radiochemotherapy in locally advanced low rectal cancer. Methods From May 2001 to August 2005, 105 patients with locally advanced low rectal cancer （T3,T4） were treated by preoperative radiotherapy to pelvis, 2. 0 Gy daily up to 40-46 Gy in 4-5 weeks concomitantly with oral capecitahine at 1250 mg· m^-2 · d^-1 for 10 weeks up to surgery. In all patients surgery was carried out under the rule of total mesorectal excision technique. Results All patients finished the course of neoadjuvant radiochemotherapy. Among them, 36 patients experienced adverse effects. Thirteen patients resulted in complete tumor response and spared the operation. Ninety-two patients were operated on with radical resection, among them 71 patients with low anterior resection, 17 with Parks＇ coloanal anastomosis and 4 with abdomino-perineal resection, so sphincter preservation was achieved in 96. 2%. In postoperative pathological studies, 11 cases showed complete tumor regression. According to the TNM staging system, 24 cases were ranged TON0, and 23 cases T2N0,43 cases T3N0, 2 cases T4N0,5 cases T2N1,8 cases T3N1; and according to Dworak＇s tumor regression grading, 5 cases were ranked TGR0, and 18 cases TGRI, 11 cases TGR2, 47 cases TGR3, 24 cases TGR4. Pathologic downstaging was achieved in 78. 1%, including complete response （TGR4） and intermediate response （TGR2 ＋ 3）. No operative death occurred. Anastomotic leakage was found in 5 cases, including 3 rectovaginal fistula. All patients have been followed up for 16-457 months, and lung metastasis occurred in 4 cases, liver metastasis in 2 patients and local recurrence in 4 patients. Three patients died of distant metastasis. The 3-year diseasefree survival was 82. 8% and overall survival was 96.5%. Condusions Neoadjuvant radiochemotherapy brings tumor down-staging and increases resectability and sphincter preservation, decreases recurrence and improves survival in locally advanced low rectal cancer.

关 键 词：直肠肿瘤 化学疗法 辅助 放射疗法 辅助 外科手术 

分 类 号：R735.37[医药卫生—肿瘤]