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FOLFOX方案联合放疗的新辅助治疗在低位直肠癌中的临床多中心研究
引用本文:汪建平,丁卫星,邓艳红,兰平,潘凯,董功航,邓建中,王磊,吴小剑,郭学锋,郑洁.FOLFOX方案联合放疗的新辅助治疗在低位直肠癌中的临床多中心研究[J].中华胃肠外科杂志,2008,11(2):116-119.
作者姓名:汪建平  丁卫星  邓艳红  兰平  潘凯  董功航  邓建中  王磊  吴小剑  郭学锋  郑洁
作者单位:1. 中山大学附属第六医院(附属胃肠肛门医院)结直肠外科,广州,510655
2. 广东省佛山市第一人民医院普通外科
3. 深圳市第一人民医院
摘    要:目的 探讨FOLFOX方案(奥沙利铂、氟尿嘧啶和甲酰四氢叶酸钙)联合放疗的新辅助治疗在低位直肠癌中应用的安全性和有效性.方法 对2004年8月至2007年7月间中山大学附属第六医院(部分资料收集开始于中山大学附属第一医院)、广东省佛山市第一人民医院和深圳市第一人民医院收治的共计56例术前评估为T3~4N0M0和T1~4N1~2M0直肠癌患者进行前瞻性临床研究,术前实施4个疗程的FOLFOX方案化疗;从化疗第2疗程的第1天开始放疗,2 Gy/次,总剂量46 Gy(共23次).放疗结束后4~8周,进行全直肠系膜切除手术.结果 56例患者共接受220个疗程化疗.其中1例患者因第2次化疗后白细胞不升而停止,只行术前放疗;1例患者在2次化疗、10次放疗后出现肺结核活动而停止治疗;余54例术前均接受4次化疗.52例患者放化疗后接受手术治疗(2例治疗后发现肝、肺、骨转移而未行手术),50例施行保肛手术,其中19例行预防性回肠造瘘.2例患者术后发生吻合口瘘,2例术后1个月出现直肠阴道瘘.52例手术后病理结果显示,7例患者完全缓解,41例患者部分缓解,4例患者稳定.56例中2例不能完成治疗退出,2例广泛转移未手术.总有效率85.7%.结论 FOLFOX方案联合放疗的新辅助治疗对于低位直肠癌患者可达到术前肿瘤降期和增加手术保肛率的效果,建议保肛术后行回肠预防性造口.

关 键 词:直肠肿瘤  药物治疗  放射治疗  新辅助疗法

Preoperative chemoradiotherapy with FOLFOX in low rectal cancer: a multicenter study
WANG Jian-ping,DING Wei-xing,DENG Yan-hong,LAN Ping,PAN Kai,DONG Gong-hang,DENG Jian-zhong,WANG Lei,WU Xiao-jian,GUO Xue-feng,ZHENG Jie.Preoperative chemoradiotherapy with FOLFOX in low rectal cancer: a multicenter study[J].Chinese Journal of Gastrointestinal Surgery,2008,11(2):116-119.
Authors:WANG Jian-ping  DING Wei-xing  DENG Yan-hong  LAN Ping  PAN Kai  DONG Gong-hang  DENG Jian-zhong  WANG Lei  WU Xiao-jian  GUO Xue-feng  ZHENG Jie
Institution:Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China. wangjianp@mail.sysu.edu.cn
Abstract:OBJECTIVE: To investigate the toxicity and safety of FOLFOX regimen concurrent with radiotherapy in neoadjuvant setting in patients with low rectal cancer. METHODS: Fifty-six patients with stage T(3-4)N(0)M(0) and T(1-4)N(1-2)M(0) were eligible from Aug. 2004 to Jul. 2007. Upon entry the study, they received 4 cycles of chemotherapy with FOLFOX regimen. Radiotherapy was added from the second cycle of chemotherapy (CT). The total dose of radiotherapy (RT) was 46 Gy (2 Gy x 23). Total mesorectal excision (TME) was performed 4-8 weeks after RT. RESULTS: Among them, 54 cases received 4 cycles of CT, 1 patient stopped CT after the second cycle of CT because of unrecovery from neutropenia. One patient stopped chemoradiotherapy(CRT) because of complicating with active pulmonary tuberculosis after 2 cycles of CT and 10 times of RT. Two occurred liver, lung and bone metastases after CT. Totally 220 cycles of CT were administrated. Fifty-two patients received operation after CRT, 50 with anal interior sphincter reservation, 19 with prophylactic ileac stoma. Anastomotic leakage occurred in 2 patients after operation, and rectal vaginal fistula in 2 patients 1 month after operation. According to the pathologic results, 7 patients achieved complete response, 41 partial response, 4 stable disease, and the objective response rate was 85.7%. CONCLUSION: Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer was safe and tolerable, and it suggests that protective ileostomy for anastomotic leakage following anus-preserving operation should be performed.
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