中低位局部晚期直肠癌术前放化疗的临床治疗分析  

Preoperative chemoradiotherapy for middle-lower and locally advanced rectal cancer

作　　者：王伟峰[1] 庄业忠[1] 黄棉生[1] 许慕明[1] 翁桢泓[1] 焦宛[1] 

机构地区：[1]汕头大学医学院附属肿瘤医院腹部外科,汕头515031

出　　处：《国际医药卫生导报》2014年第12期1694-1697,共4页International Medicine and Health Guidance News

摘　　要：目的探讨卡培他滨联合放疗同步治疗中低位局部晚期直肠癌的有效性。方法回顾分析我院2009年1月至2012年12月收治的36例行术前放化疗的Ⅱ～Ⅲ期直肠癌（T3～4／N＋）病人。术前放疗量1．8-2．0Gy／（25f·5w），总量45—50Gy。放疗期间同时服用卡培他滨1650mg／（m^2·d）。放化疗结束后5—8周行全直肠系膜切除术。结果治疗前临床分期：ⅡB期5例，ⅢB期22例，ⅢC期9例。经放化疗后，pCR4例，PR21例，SD11例。PR＋CR共25例，占69．4％。手术后病理分期：0期4例，Ⅰ期5例，ⅡA期5例，ⅡB期8例，ⅢA期1例，ⅢB期6例，ⅢC期7例。23例行保肛手术，其中11例行末段回肠预防造口。出现吻合口瘘4例，吻合口瘘率17．4％。结论卡培他滨联合放疗同步治疗中低位局部晚期直肠癌可达到术前肿瘤降期，提高根治性切除率，降低肿瘤局部复发。对保肛手术，建议行末段回肠预防造口。Objective To investigate the effectiveness of capecitabine combined with radiation as preoperative chemoradiotherapy （CRT） for patients with middle-lower and locally advanced rectal cancer. Methods From Jan 2009 to Dec 2012, 36 patients with stage Ⅱ - Ⅲ （T3-T4/N＋） rectal cancer were treated with CRT in our hospital. The dose of radiation was 1.8 - 2.0 Gy/ （ 25 f · 5 w ） with total dosage of 45 - 50 Gy. The dose of capecitabine was 1650 mg/（ m2 · d ） for 25 days. Total mesorectal excision surgery was performed 5 - 8 weeks after CRT. Results Before CRT, the patients＇ clinical stage classification： stage Ⅱ B 5 cases, m B 22 cases, and Ⅲ C 9 cases. After CRT, 4 cases achieved complete response, 21 cases partial response, and 11 cases stable disease. 25 cases got total objective response, with a response rate of 69.4%. The patients＇ pathological stage after operation： stage 0 4 cases, stage Ⅰ 5 cases, Ⅱ A 5 cases, Ⅱ B 8 cases, ⅢA 1 case, Ⅲ B 6 cases, and Ⅲ C 7 cases. Conclusions Capecitabine combined with radiotherapy as CRT are preferred treatment for patients with middle-lower and locally advanced rectal cancer. It can bring the tumor stage down and shrinkage tumor volume, improve the resection rate, and reduce recurrence. Our clinical data suggests that prophylactic ileostomy prevents anastomotic leakage following anus-preserving rectal operation.

关 键 词：直肠肿瘤 药物治疗 放射治疗 新辅助疗法 

分 类 号：R735.37[医药卫生—肿瘤]