直肠癌的术前单独放疗与联合放疗、化疗的疗效比较

目的:分析直肠癌的临床病理变化特征,对术前放疗和联合放疗、化疗的疗效进行评价。方法:146例直肠癌患者分为术前放疗组(组1)31例,放、化疗组(组2)115例。放疗总剂量为45 Gy,每周5次,每次1.8 Gy。全身化疗共2个疗程,四氢叶酸静脉滴入,随后静脉给予5-氟尿嘧啶。辅助治疗完成后4～6周采取手术治疗。结果:治疗中出现的并发症,除了组2的皮肤红斑症较多以外,其它并发症无显著差异。术后并发症最多的是切口延迟愈合,其次为肠梗阻,两组患者术后并发症没有显著差异。腔内B超和CT显示肿瘤大小的减少在组1为45.1%,组2为75.6%。术后病理显示,淋巴结减少在两组中均有明显效果。总复发率在组1为35.4%,组2为20%,且两组患者都表现出远处转移的发生率比局部复发率高。结论:术前放、化疗与单独放疗相比较,治疗中和术后并发症无显著差异;而病理学治疗效果,前者明显优于后者。

Comparation of Preoperative Chemoradiation with Radiation Only for Locally Advanced Rectal Cancer

Objective:To assess the efficacy and toxicity of the preoperative radiotherapy with or without chemotherapy in local- ly advanced rectal cancer.Methods:146 patients(clinically diagnosed stages above or equal to Astler-coller stage B2 without dis- tant metastasis)were assigned to preoperative radiotherapy arm(n=31)or combined preoperative radiotherapy and chemother- apy arm(n=115).Preoperative radiotherapy of 45 Gy to whole pelvis /- 5.4 Gy boost to primary site and concurrent chemo- therapy of 2 cycle of 5-Fu(500 mg/m~2)and folinic acid were used.31 patient of preoperative radiotherapy alone arm and 115 of combined arm received surgical resection after preoperative treatment.Results:overall treatment related toxicity rate was similar in both group except erthema on perineal skin,which was more frequent in group two than in group one.Most frequent postop- erative complication was wound infection followed by intestinal obstruction,but there was no significant difference between two groups. Tumor depth was downstaged in 45.1% of group one and 75.6% of group two patient on preoperative CT staging,and nodal down- staging was more effective on the respect of postoperative pathological report.Overall recurrence rate was 35.4% in group one and 20% in group two.Of these,failure occurred first as a distant metastasis more frequently than as a local recurrence in both group. Conclusion:These data do suggest that the preoperative chemotherapy and radiotherapy used are as safe as preoperative radiotherapy a- lone.Furthermore,tumor and lymph node downstaging are more effective in combined arm.