Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.

PURPOSE: The present study compares quality of life (QoL) after neoadjuvant radiochemotherapy with or without hyperthermia in patients with advanced rectal cancer. METHODS: Between April 1994 and May 1999, 137 patients were treated by neoadjuvant radiochemotherapy with (69 patients (50.4%)) or without (68 patients (49.6%)) hyperthermia. Forty-six patients (33.6%) filled-out a 'Gastrointestinal Quality of Life Index' (GIQLI) questionnaire at four time points (before and after neoadjuvant therapy, early after surgery and after long-term follow-up) and were included in the present study. RESULTS: There were no statistically significant differences in the global GIQLI index between patients treated with neoadjuvant radiochemotherapy with and without hyperthermia at any time point. The longitudinal analysis of GIQLI values in both treatment groups showed specific profiles that were identical in both treatment groups. Occurrence of severe toxicity during the neoadjuvant therapy in both arms lead to a significant temporary reduction of QoL scores at TP2 without any detrimental long-term effects. Patients with sphincter preservation and patients with sphincter resection reported similar QoL scores during long-term follow-up. CONCLUSION: Neoadjuvant radiochemotherapy with and without hyperthermia has similar effects on the QoL of patients with locally advanced rectal cancer. The addition of hyperthermia during the neoadjuvant therapy with the potentially associated inconveniences has no negative effects on QoL.     

Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone

Purpose: To evaluate the influence of regional hyperthermia on rates of complete pathological response (pCR) and sphincter-sparing surgery in the context of an up-to-date radiochemotherapy protocol for locally advanced rectal cancer.

Methods: Between 2007 and 2010, 106 patients with locally advanced cancer of the middle and lower rectum were admitted to neoadjuvant radiochemotherapy either with (n?=?61) or without (n?=?45) regional hyperthermia. A retrospective comparison was performed between two groups: 45 patients received standard treatment consisting of 5040 cGy in 28 fractions to the pelvis and 5-fluorouracil (RCT group) and 61 patients received the same treatment in combination with regional hyperthermia (HRCT group). Target temperature was 40.5°C for at least 60?min. Total mesorectal excision was performed routinely.

Results: pCR was seen in 6.7% of patients in the RCT group and 16.4% in the HRCT group. Patients who received at least four hyperthermia treatments (n?=?40) achieved a significantly higher pCR rate (22.5%) than the remaining 66 patients (p?=?0.043). Rates of sphincter-sparing surgery were similar in both groups with 64% in the RCT group and 66% in HRCT. When considering only low-lying tumours located within 8?cm of the anal verge prior to treatment, the rate of sphincter-sparing surgery was 57% in the HRCT group compared with 35% in the RCT group (p?=?0.077).

Conclusion: The combination of regional hyperthermia and neoadjuvant radiochemotherapy may lead to an increased pCR rate in locally advanced rectal cancer. Patients with low-lying tumours especially may benefit when additional downsizing allows sphincter-preserving surgery.     

Long-term local control and survival after preoperative radiochemotherapy in combination with deep regional hyperthermia in locally advanced rectal cancer

Purpose: The aim of this study was to evaluate the impact of deep regional hyperthermia on long-term local control and survival in locally advanced non-metastatic rectal cancer. Methods: In total 103 patients with locally advanced non-metastatic rectal cancer were treated preoperatively with either neoadjuvant radiochemotherapy alone (n?=?43) or the same treatment with additional deep regional hyperthermia (n?=?60). The two groups were compared with respect to local control, overall survival (OS), disease-free survival (DFS), and distant metastases-free survival (DMFS). Results: Patients receiving additional hyperthermia had excellent long-term local control with a 5-year Kaplan-Meier estimate of 98% compared with 87% in the radiochemotherapy only group (p?=?0.09). Five-year rates for OS (88% versus 76%, p?=?0.08), DFS (77% versus 73%, p?=?n.s.) and DMFS (75% versus 77%, p?=?n.s.) were not statistically different between the two groups. Conclusion: Radiochemotherapy combined with hyperthermia results in excellent long-term local control.     

Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy

Purpose: The aim of this report was to determine the impact of hyperthermia (HT) on preoperative radiochemotherapy for locally advanced rectal cancer.

Materials and methods: Between 1996 and 2007, 235 patients with locally advanced rectal cancer were treated with concurrent preoperative radiochemotherapy with or without HT. The total dose of radiotherapy was 39.6?Gy for 109 patients (group A) and 45?Gy for 126 patients (group B). Two or three cycles of chemotherapy were administered. Hyperthermia was given immediately after radiotherapy.

Results: In the HT subgroup of group A, more patients achieved down-staging of T stage when compared to the non-HT subgroup (57.9% versus 38%, p?=?0.047). For the cN+ subgroup of all patients, the number of patients with ypN+ were significantly less in the HT subgroup (25% versus 50%, p?=?0.022). In group A, HT appeared to reduce distant metastasis, increase disease-free survival, and improve overall survival.

Conclusions: HT seemed to increase the response of both primary tumour and lymph nodes to preoperative radiochemotherapy in patients with locally advanced rectal cancer. The relationship between increased response by HT and survival should be confirmed by a large prospective randomised trial.     

新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响

目的:探讨新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响。方法:回顾性分析2013年至2016年我院185例局部进展期直肠癌行直肠低位前切除术患者的临床和病理资料,采用低位前切除综合征（LARS）评分量表评估患者术后排便功能状况,通过单因素和多因素Logistic回归分析影响患者术后排便功能的危险因素。结果:所有患者均严格遵循直肠全系膜切除术（TME）原则行低位前切除术,其中113例行术前（新辅助）放化疗,50例行术后（辅助）放化疗,22例未行放化疗。术后12～48个月中,患者中LARS的发生率为64.9%,重度LARS的发生率为31.9%,重度LARS患者占全部LARS患者的49.2%。单因素分析发现,接受放化疗者术后重度LARS发生比例显著高于未接受放化疗者（P＜0.001）,肿瘤距肛缘距离＜5 cm者术后重度LARS发生比例显著高于≥5 cm者（P=0.001）,开放手术者术后重度LARS发生比例显著高于腹腔镜手术者（P=0.038）,然而放化疗的不同时机（新辅助、辅助）、新辅助放化疗的不同形式（长程放化疗、短程放疗）对术后重度LARS发生比例的影响,差异并无统计学意义（P＞0.05）。多因素分析发现,只有放化疗（P=0.001）、肿瘤距肛缘距离＜5 cm（P=0.003）是术后发生重度LARS的独立危险因素。结论:LARS是直肠癌保肛术后长期困扰患者的常见并发症,放化疗、肿瘤位置较低是导致术后LARS的独立危险因素。然而,新辅助放化疗与辅助放化疗,长程放化疗与短程放疗对术后LARS发生的影响基本相似。     

Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin

Purpose: Prospective assessment of quality of life (QoL) in patients with refractory, residual or recurrent ovarian cancer receiving whole abdomen hyperthermia and intravenous liposomal doxorubicin chemotherapy.

Methods: Treatment consisted of six cycles of intravenous liposomal doxorubicin at 40?mg?m² followed by whole abdomen hyperthermia with each cycle delivered every 4 weeks. QoL assessment was performed at baseline, prior to each cycle of chemotherapy and every 3 months during follow-up using self-administered questionnaires. Global QoL was rated on a seven-point scale and specific domains of QoL, disease related symptoms and treatment related toxicity were rated on a four-point scale.

Results: Thirty-two patients were enrolled on the study and 129?QoL questionnaires were completed. Average age was 57.9 (range 45–76); nine patients had persistent and 23 recurrent disease. Ten patients completed six cycles of therapy. Three patients returned follow-up surveys. Subjects rated their overall QoL and health at baseline as above average with mean scores 5.10 (95% CI?=?4.62?5.58) and 4.66 (95% CI?=?4.23?5.08), respectively. No significant change in overall QoL was found between baseline and cycles 4–6 of therapy. Mean ratings of overall health and subject reported differences in QoL between cycles were not significantly changed during therapy. Limited follow-up data were available, but scores suggest possible improvement in QoL for patients completing all therapy. Subjects rated the greatest negative impact on QoL in areas of role functioning and social functioning, where the mean (SD) over all cycles was 2.00 (0.67) and 1.98 (0.70), respectively. For physical symptoms, fatigue and sleep disturbance had the most negative impact on QoL with means (SD) of 2.26 (0.62) and 1.91 (0.70). The moderate treatment related toxicity seen in this study did not significantly impact patients reported QoL.

Conclusions: Patients with unfavourable ovarian cancer responding to intravenous liposomal doxorubicin and whole abdomen hyperthermia maintained above average QoL during therapy. Limited data on patients completing protocol therapy demonstrated possible improvement in QoL.     

Long-term quality-of-life after neoadjuvant short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer

Purpose

To evaluate long-term quality-of-life (QoL) after neoadjuvant short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer.

Methods

Between 1999 and 2008, 225 patients were treated with curative intent for locally advanced rectal cancer using neoadjuvant SC-RT (n = 108) or LC-RCHT (n = 117). SC-RT delivered 10 × 2.9 Gy twice daily with immediate surgery. LC-RCHT delivered 28 × 1.8 Gy concomitant with 5-FU based chemotherapy and delayed surgery. A cross-sectional QoL analysis was performed in disease-free patients using the EORTC-QLQ-C30 and EORTC-QLQ-CR29 questionnaires.

Results

After a median follow-up of 67 months, 133 patients were disease-free of which 120 (90%) returned the QoL questionnaires. Patients in the LC-RCHT cohort had a higher rate of uT4, uN+ and low tumor location. No difference in QoL was observed between SC-RT and LC-RCHT except an improved physical functioning in the LC-RCHT group (p = 0.04). Comparing our total patient cohort with the general German population showed no difference in global health status but decreased QoL in several functional and bowel symptom scores.

Conclusions

The finding of comparable long-term QoL after SC-RT and LC-RCHT adds to our knowledge of equivalent oncological outcome and may be useful in the decision making process between the two neoadjuvant approaches.     

Phase I/II trial of intravenous Doxil® and whole abdomen hyperthermia in patients with refractory ovarian cancer

Objective: A phase I/II study of Doxil® combined with whole abdomen hyperthermia was conducted in patients with refractory ovarian cancer. Liposomal doxorubicin combined with hyperthermia has been shown to increase both liposomal delivery and drug extravasation into tumour xenografts resulting in enhanced cytotoxic effects.

Patients and methods: Thirty patients with either recurrent or persistent epithelial ovarian cancer were enrolled. All patients had either measurable or assessable disease. Patients received intravenous (IV) Doxil® at a dose of 40?mg?m^?2 as a 1-h infusion followed by whole abdomen hyperthermia. The phase I portion of the study was performed to determine the maximal tolerated dose (MTD) of hyperthermia. Quality of life (QoL) was performed at baseline, prior to each cycle and every 3 months. Plasma pharmacokinetic studies were performed with the first cycle.

Results: Ten patients participated in the phase I portion of the study which demonstrated that the MTD of hyperthermia was 60?min after either average vaginal and rectal temperatures of 40°C had been achieved or after 30?min of power application, whichever was shorter. All 30 patients were either paclitaxel and/or platinum resistant initially or developed resistant disease. The median number of prior chemotherapeutic regimens was three (range 2–8) and six patients had been previously treated with Doxil®. There were three partial responses for a response rate of 10% (95% CI: [2%, 27%]) and eight patients (27%; 95% CI: [12%, 46%]) had disease stabilization. The median time to progression or death was 3.4 months (95% CI: [2.6, 5.2]) and the median survival was 10.8 months (95% CI: [8.8, 17.4]). Twelve patients (40%) experienced palmar-plantar erythrodysesthesia (PPE), but only four (13%) experienced grade 3–4 PPE toxicity. Doxil® systemic exposure was higher in those with grade 3–4 PPE compared to those with no PPE. None of the patients had grade 3–4 thermal toxicity due to hyperthermia. QoL was not decreased in patients responding to therapy.

Conclusions: Therapy with intravenous Doxil® and whole abdomen hyperthermia for patients with platinum/paclitaxel resistant ovarian cancer is feasible and does not negatively impact quality of life.     

Hyperthermia combined with radiation in treatment of locally advanced prostate cancer is associated with a favourable toxicity profile

Purpose:?Hyperthermia is used to treat several pelvic tumours. An important step in establishing a broader role for hyperthermia in treatment of prostate cancer is verification of an acceptable toxicity profile. In this report, short- and long-term toxicity profiles of a completed phase II trial of transrectal ultrasound hyperthermia combined with radiation in treatment of locally advanced prostate cancer are presented.

Methods and materials:?Thirty-seven patients enrolled on a phase II study of external beam radiation?±?androgen suppression with two transrectal ultrasound hyperthermia treatments were assessed for short- and long-term toxicity. Prostatic and anterior rectal wall temperatures were monitored. Rectal wall temperatures were limited to 40°C (19 patients), 41°C (three patients) and 42°C (15 patients). Univariate logistic regression was used to estimate the log hazard of developing NCI CTC Grade 2 toxicity based on temperature parameters. Hazard ratios, 95% confidence intervals, p-values for statistical significance of each parameter and proportion of variability explained for each of the parameters were calculated.

Results:?Median follow-up was 42 months. Both short- and long-term GI toxicity were limited to grade 2 or less. Acute grade 2 proctitis was greater for patients with allowable rectal wall temperature of >40°C. Eleven of 18 patients in this group had acute grade 2 proctitis vs three of 19 patients with rectal wall temperatures limited to 40°C (p?=?0.004). Long-term grade 2 GI and GU toxicity occurred in 5% and 19% of patients. No late grade 3 or greater toxicity occurred. Late GI and GU toxicity were not associated with the allowable rectal wall temperature.

Conclusion:?Transrectal ultrasound hyperthermia combined with radiation for treatment of advanced clinically localized prostate cancer is safe and well tolerated.     

Short-course preoperative radiotherapy combined with chemotherapy,delayed surgery and local hyperthermia for rectal cancer: a phase II study

Purpose: The aim of this study was to investigate the feasibility of short-course radiotherapy with oral capecitabine, hyperthermia and delayed surgery for neoadjuvant treatment of rectal cancer.

Methods: Patients with clinically staged T2-3N0-2M0 primary rectal cancer were included. All patients received short-course 25?Gy in 5?Gy fractions radiotherapy with capecitabine, local hyperthermia and metronidazole. Capecitabine 1000?mg/m² twice a day was given on days 1–14. Local hyperthermia, 41–45?°C for 60?min, was performed on days 3–5. Metronidazole 10?g/m² was administered per rectum on days 3 and 5. The time interval to surgery was not less than four weeks after neoadjuvant treatment. The primary end-point was pathological complete response (pCR). Secondary end-points included neoadjuvant treatment toxicity, tumour regression, surgical and oncological outcomes.

Results: A total of 81 patients were included in the analysis. Ten (12.3%) patients had grade 3 toxicity and one (1.2%) patient had grade 4 toxicity. Sphincter-sparing surgery was performed for 78 (96.3%) patients. There was no postoperative mortality. Postoperative complications occurred in 11 (13.8%) patients. Sixteen (20%) patients had a pCR. The median follow-up was 40.9 months. There were no local recurrences. Nine (11.1%) patients developed distant metastases. Three-year overall survival was 97% and the three-year disease-free survival was 85%.

Conclusions: Short-course radiotherapy with chemotherapy, radiosensitizers and delayed surgery is a feasible treatment for rectal cancer and may lead to tumour regression rate comparable with long-course chemoradiation.     

新辅助同步放化疗联合全系膜切除对局部进展期中低位直肠癌的治疗价值

目的探讨新辅助同步放化疗联合直肠全系膜切除术(total mesorectal excision,TME)用于局部进展期中低位直肠癌治疗的可行性与临床价值。方法111例局部进展期(T3～4 N0～2 M0)中低位直肠癌术前接受同步放化疗,放疗剂量50 Gy,化疗包括奥沙利铂+卡培他滨的联合化疗方案及不含铂类药物的单药化疗方案。共105例患者同步放化疗结束后2～10周内完成了肿瘤根治性(R0)手术,可进行疗效的病理学评价。结果105例患者获得根治性切除,切缘均阴性,42例(37.8%,42/111)患者成功实施保肛手术;18例临床-影像分期为T4期患者中,15例(83.3%)新辅助放化疗后获得根治性切除(R0)。所有患者手术及术后恢复顺利,无严重手术并发症;术后病理示肿瘤完全消退15例(14.3%),重度消退26例(24.8%),中度消退40例(38.1%),轻度及无消退24 例(22.8%)。结论新辅助同步放化疗联合TME手术安全可行,可提高局部进展期中低位直肠癌的根治性切除率与保肛率,不增加手术并发症,是局部进展期中低位直肠癌的优选治疗模式。     

Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer

Multimodality treatment of rectal cancer, with the combination of radiation therapy, chemotherapy, and surgery has become the preferred approach to locally advanced rectal cancer. The use of neoadjuvant chemoradiation therapy (CRT) has resulted in reduced toxicity rates, significant tumor downsizing and downstaging, better chance of sphincter preservation, and improved functional results. A proportion of patients treated with neoadjuvant CRT may ultimately develop complete clinical response. Management of these patients with complete clinical response remains controversial and approaches including radical resection, transanal local excision, and observation alone without immediate surgery have been proposed. The use of strict selection criteria of patients after neoadjuvant CRT has resulted in excellent long-term results with no oncological compromise after observation alone in patients with complete clinical response. Recurrences are detectable by clinical assessment and frequently amenable to salvage procedures.     

A phase I/II study of neoadjuvant liposomal doxorubicin,paclitaxel, and hyperthermia in locally advanced breast cancer

Purpose: The prognosis for locally advanced breast cancer (LABC) patients continues to be poor, with an estimated five-year survival of only 50–60%. Preclinical data demonstrates enhanced therapeutic efficacy with liposomal encapsulation of doxorubicin combined with hyperthermia (HT). Therefore this phase I/II study was designed to evaluate the safety and efficacy of a novel neoadjuvant combination treatment of paclitaxel, liposomal doxorubicin, and hyperthermia.

Materials and methods: Eligible patients received four cycles of neoadjuvant liposomal doxorubicin (30–75 mg/m²), paclitaxel (100–175 mg/m²), and hyperthermia. They subsequently underwent either a modified radical mastectomy or lumpectomy with axillary node dissection followed by radiation therapy and then eight cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy.

Results: Forty-seven patients with stage IIB-III LABC were enrolled and 43 patients were evaluable. Fourteen patients (33%) had inflammatory breast cancer. Combined (partial + complete) clinical response rate was 72% and combined pathological response rate was 60%. Four patients achieved a pathologically complete response. Sixteen patients were eligible for breast-conserving surgery. The cumulative equivalent minutes (CEM 43) at T90 (tenth percentile of temperature distribution) was significantly greater for those with a pathological response. Four-year disease-free survival was 63% (95% CI, 46%–76%) and the four-year overall survival was 75% (95% CI, 58–86%).

Conclusions: Neoadjuvant therapy using paclitaxel, liposomal doxorubicin and hyperthermia is a feasible and well tolerated treatment strategy in patients with LABC. The thermal dose parameter CEM 43 T90 was significantly correlated with attaining a pathological response.     

Cancers du bas rectum: comment améliorer la conservation sphinctérienne ?

There are currently numerous challenges in the management of lower rectal cancers. Even though abdominoperineal amputation is still considered the surgical gold standard in this topography, the significant advances in terms of surgery techniques that are able to ensure clear margins have increased sphincter conservation indications. In this setting, the role of combined radiochemotherapy is still controversial even if its local efficacy is demonstrated in number of studies, which have indicated the possibility to adapt surgery to the type of local response after neoadjuvant treatment. The future challenges for the combined strategy is to allow better personalization of treatment to increase outcome of patients and provide higher rates of the local responses that are required for sphincter conservation with low-risk of morbidity. In this review, we aimed to discuss the multidisciplinary management advances and perspectives in terms of neoadjuvant combined therapy for sphincter-saving resection in lower rectal cancers.     

Still proliferating CD44+/Ki67+ tumor cells after neoadjuvant radiochemotherapy identify rectal cancer patients with poor survival

IntroductionDistant recurrence, especially liver metastases, occurs in one-third of rectal cancer patients initially treated with curative therapy and is still an unsolved problem. The identification of patients at risk is crucial for enabling individualized treatment.Material and methodsAll patients undergoing curative resection for histologically confirmed rectal cancer after neoadjuvant radiochemotherapy between January 2001 and December 2015 were included. Sections were stained for Ki67, CD44, apoptosis and CD133. Patients were categorized based on whether they were found to have (CD44⁺/Ki67⁺) or not have (CD44⁺/Ki67⁺) still proliferating tumor cells.Results218 patients who underwent R0 resection for stage I-III rectal cancer were selected. In 37 (17%) of these patients, CD44⁺/Ki67⁺ tumor cells were found. In multivariable Cox regression analysis, patients with CD44⁺/Ki67⁺ cells had significantly impaired overall (hazard ratio (HR): 3.84, 95% CI: 1.77–8.31, p = 0.001) and relative survival (HR 3.44, 95% CI: 1.46–8.09). The previous results were confirmed after propensity-score matching. In mediation-analysis, the presence of CD44⁺/Ki67⁺ cells was associated with a substantial direct effect on overall (HR 1.92, 95% CI: 1.09–9.28) and relative survival (HR 1.63, 95% CI: 1.31–6.38).ConclusionsThe presence of still proliferating CD44⁺/Ki67⁺ tumor cells after neoadjuvant radiochemotherapy was associated with impaired oncological long-term outcomes. Characterization of these cells should be performed.     

中低位进展期直肠癌患者全直肠系膜切除术前应用同步新辅助放化疗效果分析

目的：分析中低位进展期直肠癌患者全直肠系膜切除术前同步新辅助放化疗应用疗效。方法选取45例中低位进展期直肠癌患者为研究对象,将其随机分为联合组（23例）与对照组（22例）,对照组患者行单纯全直肠系膜切除术,联合组患者在行全直肠系膜切除术前同步新辅助放化疗,比较联合组新辅助放化疗前后肿瘤分期（TNM）情况,两组患者治疗前后肿瘤标志物水平变化情况及术后3个月保肛率、复发率、转移率、术后并发症发生情况。结果新辅助治疗后联合组TNM分期较治疗前降低,差异具有统计学意义（P﹤0.05）;治疗前两组患者癌胚抗原（CEA）、糖链抗原19-9（CA19-9）、糖链抗原242（CA242）水平差异无统计学意义（P﹥0.05）,治疗后均降低（P﹤0.05）,且联合组低于对照组（P﹤0.05）;两组患者术后3个月转移率及并发症发生率差异无统计学意义（P﹥0.05）,联合组保肛率高于对照组,复发率低于对照组（P﹤0.05）。结论采用全直肠系膜切除术前同步新辅助放化疗,可以有效提高中低位进展期直肠癌患者保肛率,降低复发率,改善肿瘤TNM分期,降低CEA、CA19-9、CA242水平,具有良好的应用前景。     

新辅助放化疗对中低位直肠癌患者排便状况的影响

目的：探讨新辅助化疗对中低位直肠癌患者排便状况的影响。方法将单纯进行手术治疗的患者纳入对照组,新辅助放化疗结合手术治疗的患者纳入研究组。比较两种治疗方法对患者术后排便功能的影响。结果新辅助放疗组患者治疗前后肿瘤距齿状线距离存在显著差异,P＜0．05;两组患者治疗后排便异常存在显著差异,P＜0．05;年龄,行辅助放化疗和直肠癌根治术后吻合口距肛缘的距离是大便失禁发生率的影响因素,P＜0．05。结论新辅助放化疗对中低位直肠癌患者,能达到提高肿瘤切除率和提高保肛成功率的目的,虽然对术后患者排便功能有一定的影响,但是也不失为一种有效的治疗方法。     

新辅助治疗在局部晚期直肠癌中的作用

综合治疗在局部晚期直肠癌治疗中日益受到重视，术前同期放化疗具有降期、降级、保肛、提高局部控制率和生存率的优点，已逐步成为直肠癌综合治疗的标准方案用于临床。     

新辅助治疗在进展期低位直肠癌术前的应用

背景与目的提高进展期低位直肠癌的根切率和保肛率是一个难题,本研究探讨术前联合放化疗(新辅助治疗)在进展期低位直肠癌中的疗效。方法23例进展期低位直肠癌患者,按术前评价均需行腹-会阴联合切除术的患者进行术前联合放化疗。放疗每周5d,每次200cGy,共4周20次,总剂量4000cGy。化疗的给药方式以放疗期间持续静脉滴注,采用草酸铂(Oxa)130mg/(m2·d1),5-FU500mg/(m2·d1-5),加CF300mg/(m2·d1-5),休息4~6周进行手术。结果15例的病例肿瘤分期降级,施行了保留肛门的直肠癌根治术,保肛率达65%(15/23),其中82%的患者肛门括约肌功能良好。结论进展期低位直肠癌的患者在接受新辅助治疗后,能使肿瘤降期,切除率增加,提高保肛率,同时副反应轻,患者依顺性较好。     

定量DCE-MRI在局部进展期直肠癌疗效评估中的应用

目的:评价定量动态增强磁共振成像(dynamic contrast enhanced-MRI,DCE-MRI)在局部进展期直肠癌患者新辅助治疗疗效评估中的应用价值。方法:收集我院34例局部进展期直肠癌患者，于新辅助治疗前、后分别行DCE-MRI检查，根据肿瘤退缩分级，将其分为有反应组（mrTRG1、mrTRG2和mrTRG3）和无反应组（mrTRG4和mrTRG5）。测量并比较治疗前后总体及两组间DCE-MRI定量参数Ktrans（容量转移常数）、Kep（速率常数）以及Ve（血管外细胞外间隙容积分数）的差异。结果:34例患者，治疗后Ktrans［治疗前、后分别为(1.48±0.80)/min，(0.88±0.45)/min，P＜0.001］、Kep［治疗前为(3.29±1.25)/min，治疗后为(2.12±1.18)/min，P＜0.001］均较治疗前减低，有反应组、无反应组的Ktrans、Ve值在治疗前和治疗后的变化差值均有统计学意义，其中，治疗前有反应组的Ktrans值为(1.93±0.81)/min、Ve值为0.59±0.27、治疗后变化差值相应为(-1.11±66)/min、-0.14±0.16，无反应组的Ktrans值为(0.82±0.49)/min、Ve值为0.35±0.16，相应的变化差值为(-0.03±19)/min、0.21±0.27。结论:定量动态增强磁共振成像对局部进展期直肠癌新辅助治疗疗效评价具有一定的价值。