低位直肠癌术前放疗联合化疗30例疗效观察

目的探讨术前放疗联合化疗在低位直肠癌治疗中的临床价值。方法2006年1月—2008年11月我们对30例低位直肠癌患者进行术前放疗联合化疗。术前放疗总剂量为30Gy,每周5次,每次3Gy,化疗基本方案为四氢叶酸200mg/次、5-Fu400mg/m^2,d1-5,放疗第一周开始。放化疗结束2～4周行手术治疗。结果全组患者14例发生Ⅰ～Ⅱ度胃肠道反应,仅1例出现Ⅲ度造血系统毒性反应。放化疗后肿瘤平均直径由40.2mm缩小至28.3mm;53.3%的患者T降期,50%的患者N降期,有2例获得病理完全缓解。结论低位直肠癌术前放疗联合化疗安全可靠,可以缩小原发肿瘤,使肿瘤分期降低,并能取得一定的肿瘤完全缓解率。术前放疗总剂量和手术间隔时间是影响疗效的重要因素。

EFFECT OF PREOPERATIVE CHEMOTHERAPY COMBINED RADIOTHERAPY ON LOW RECTAL CANCER: A REPORT OF 30 CASES

Objective To explore the clinical value of combined preoperative radiotherapy with chemotherapy on low rectal carcinoma. Methods From Jan 2006 to Nov 2008,30 cases with locally advanced low rectal carcinoma received a new regimen of combined preoperative radiotherapy with chemotherapy. Radiotherapy was given with a total dose of 30 Gy,5 time per week,with Ⅲ Gy per fraction.Patients olso received CF（200mg）,5-Fu（400mg/m2） for 1-5 days in the first week of radiation.Operations were performed 2-4 weeks after neoadjuvant therapy. Results There was gradeⅠ～Ⅱacute toxicity in the gastrointestinal system of 14 patients,grade Ⅲ hematological toxiety in 1 patient. After preoperative chemoradiotherapy,the average diameter of tumor decreased from 40.2mm to 28.3mm.Tumor stage decreased in 53.3% and nodal stage decreased in 50% patients.Two patients received complete pathological response. Conclusion Preperative radiochemotherapy is proved to be a safe method,which can shrink tumor and decrease tumorstage.Some extent of complete pathological response can be achieved by preoperative radiothemotherapy.The dose of radiation and the interval time between neo-adjuvant and operation are two influential aspects to the effect.