新辅助放化疗对低位进展期直肠癌保肛术式选择的影响  

Effect of neoadjuvant chemoradiotherapy in treatment of advanced lower rectal cancer

作　　者：杨兴东[1] 张尤亮 李泽楠[1] 谷英涛[1] 王守印[1] 李金锁[1] 杨旭华[1] 金伟森[1] 

机构地区：[1]武警总医院肛肠病研究所,北京100039 [2]武警广西总队医院外一科,南宁530003

出　　处：《武警医学》2009年第7期594-596,共3页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨新辅助放化疗对低位进展期直肠癌术式选择的影响。方法回顾性研究98例低位进展期直肠癌患者(TNMⅢ期)。将患者分成2组,A组(n=48)术前新辅助放化疗:放疗每周5d,疗程4～5周,22次,总剂量45～50Gy,同时XELOX方案化疗3个周期。放疗结束后6～8周进行手术。B组(n=50)为同期直接手术。分析两组患者手术并发症及3年无瘤生存率。结果A组48例中,42例(87.5%)降期,其中15例(31.3%)达到完全缓解,最终保肛率达93.7%。B组保肛率只有72%。结论术前新辅助放化疗对低位进展期直肠癌确实能达到肿瘤降期,直接影响术式的选择,提高手术切除率和保肛成功率,从而提高患者的生存质量。Objective To evaluate the effect of neoadjuvant chemoradiotherapy in the sphincter preserving surgery and rectal cancer resection with locally advanced low rectal cancer （ TNM Ⅲ ）. Methods Ninety - eight patients with TNM Ⅲ lower rectal cancer were divided into 2 groups. Group A was first treated by preoperative radiotherapy of pelvis, 2.0 Gy daily up to 45 - 50 Gy in 4 - 5 weeks. Surgical operations were performed 4 - 6 weeks after radio - therapy. Preoperative courses of XELOX were given concomitantly for 10 weeks. Operations were performed for patients in group B （N =50） without adjuvant therapy. Results In group A, 42 patients （87.5%）had been down- staged. Fifteen out of 48 patients had clinical complete response. 45 patients （93.7%） had sphincter preserving surgery and radical operations. Miles operation was performed on three patients only. Local recurrence rate reached only 6.3%. Conclusions Neoadjuvant therapy shows high efficacy in tumor down - staging and shrinkage of tumor mass and improves the resection rate and sphincter preservation for advanced lower rectal cancer.

关 键 词：低位进展期直肠癌 新辅助放化疗 保肛手术 

分 类 号：R735.34[医药卫生—肿瘤]