新辅助同步放化疗联合TME及术后辅助化疗对中低位局部进展期直肠癌的疗效研究  

Neoadjuvant Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in the Treatment of Locally Advanced Middle and Lower Rectal Cancer

作　　者：闫玉虎[1] 谢敏[1] 陈卫东[1] 常青[1] 张克亮[1] 

机构地区：[1]湖北省肿瘤医院,430079

出　　处：《实用癌症杂志》2014年第6期669-671,共3页The Practical Journal of Cancer

摘　　要：目的探讨新辅助同步放化疗联合全直肠系膜切除（TME）加术后辅助化疗三联疗法治疗中低位局部进展期直肠癌的疗效及安全性.方法选择局部进展期中低位直肠癌Ⅱ、Ⅲ期（T2N＋M0,T3-4N0-2M0期）65例,术前放疗总剂量50～54Gy,术前采用Xelox方案化疗3个疗程,放化疗结束后6～8周根据TME原则行直肠癌根治术.术后采用Forfox4方案辅助化疗6个疗程.结果65例均完成新辅助同步放化疗、手术治疗及术后辅助化疗.其中48例行Dix-on’s手术,17例行mile’s手术,保肛率73.85%,术后并发症发生率23.08%,其中伤口感染延期愈合6例,吻合口瘘4例,吻合口狭窄5例,手术后病理完全缓解（pCR）11例,占16.92%.结论新辅助放化疗＋TME手术治疗＋术后辅助化疗三联疗法治疗中低位进展期直肠癌安全有效,可以降低肿瘤分期,减少局部复发及远处转移,中远期疗效好.Objective To evaluate the efficacy and safety of neoadjuvant concurrent chemoradiotherapy combined with TME( total mesorectal excision) for the treatment of locally advanced middle and lower rectal cancer. Methods 65 patients with stage Ⅱ( T2N + M0) and Ⅲ( T3-4N0-2M0) locally advanced middle and lower rectal cancer were recruited. All patients received neoadjuvant concurrent chemoradiotherapy( the total dose of preoperative radiotherapy was 50-54 Gy,concurrently combined with3 cycles of Xelox regimen). The surgical operation was performed 6-8 weeks later,following the principle of TME. All patients after operation received 6 cycles of Folfox4 regimen. Results All patients completed the neoadjuvant concurrent chemoradiotherapy,operation and neoadjuvant concurrent chemotherapy. 48 patients received low /ultra-low anterior resection( Dixon),and 17 patients received abdominoperineal resection( Miles). The sphincter preservation rate was 73. 85%. 11 patients( 16. 92%) obtained pathologic complete response. Postoperative complication rate was 23. 08%,of which 6 cases had delayed healing wound infections,4 cases had anastomotic leakage,anastomotic stricture 5 cases. Conclusion Neoadjuvant concurrent chemoradiotherapy combined with TME and chemotherapy after operation for treatment of locally advanced middle and lower rectal cancer is effective and safe,which can reduce the tumor stage and have a better long-term outcome.

关 键 词：夜香树花甾体皂苷 K562细胞 细胞凋亡 PI3K/AKt信号通路 

分 类 号：R735.37[医药卫生—肿瘤]