新辅助治疗联合盆腔脏器切除术治疗复发直肠癌

目的探讨新辅助治疗联合盆腔脏器切除术对复发直肠癌的临床治疗价值。方法对35例复发直肠癌患者,采用新辅助治疗方案。常规分次放疗,放疗总剂量(DT)46Gy,每周5次,每次2Gy。全身化疗2个疗程,每次予以奥沙利铂130mg/m2,第1天静脉点滴;甲酰四氢叶酸钙(CF)200mg/m2,第1~3天静脉点滴;氟脲嘧啶(5-Fu)500mg/m2,第1~3天静脉点滴。治疗结束后4~6周进行盆腔脏器切除手术。结果经新辅助治疗后,病理完全缓解6例,肿瘤平均缩小38.4%,65.7%的病例T期下降。全组无手术死亡,R0切除率为88.5%,手术并发症发生率为13.3%。本组总的3年生存率为82.8%;5年生存率为48.5%;其中获得R0切除的患者,3年生存率为90.3%,5年生存率为54.6%。结论新辅助治疗联合盆腔脏器切除术是治疗复发直肠癌的有效方法。通过降低肿瘤病期,提高手术切除率,从而提高患者生存率。

Neoadjuvant chemoradiotherapy combined with pelvic exenteration for locally recurrent rectal cancer

Objective To explore clinical value of neoadjuvant chemoradiotherapy (NCR) in combination with pelvic exenteration in treatment of locally recurrent rectal cancer. Methods Thirty-five cases with locally recurrent rectal cancer were treated with a new regiment of combined preoperative chemotherapy with radiotherapy. Routine fraction of radiation was given with total dose of 46 Gy, 2 Gy per fraction, five times a week. Cases received oxaliplation at 130 mg/m2 (infusion) at day 1 and leucovorin at 200 mg/m2 and 5-Fu at 500 mg/m2 from day 1 to day 3 for total two treatment course before irradiation. Then, pelvic exenteration was performed 4-6 weeks after NCR. Results After NCR, complete pathologic response was seen in six cases, with average tumor size reduction of 38.4% and tumor stage decrease of 65.7%. No perioperative death occurred, with R_0 resection rate of 88.5% and postoperative complication rate of 13.3%. The overall 3-and 5-year survival rates were 82.8% and 48.5% respectively. The 3-and 5-year survival rates were 90.3% and 54.6% respectively in 31 cases with R_0 resection. Conclusion NCR combined with pelvic exenteration can obtain satisfactory treatment results by down-staging tumor and increasing resectability to improve long term survival of the cases and hence is an effective way for treatment of locally recurrent rectal cancer.