ֱ������ǰ�Ż��ƺ���ȫ���ⲡ���Ĵ���

目的 探讨直肠癌经术前放化疗后获得完全缓解病例的处理方法.方法 对北京协和医院1997-2007年实施术前放化疗的69例直肠癌进行分析.肿瘤平均距肛缘5.0cm,临床分期,13、14期.所有病人均接受术前放疗(2Gy×25),或辅以5-FU/亚叶酸钙为基础的同步化疗.放疗结束后4-6周接受全直肠系膜切除(TME)原则的外科手术.结果 有2例获得临床完全缓解,因拒绝手术在不同时间内均出现局部复发和远处转移.67例手术病人中病理完全缓解7例(10.15%),术后随访12-38个月均未出现肿瘤复发或疾病进展.结论 在目前没有充分循证医学证据的情况下,应谨慎对待术前放化疗后完全缓解的直肠癌病例,不建议采用非手术治疗.

Management of complete response after neoadjuvant therapy in mid-low rectal cancer

??Objective:To discuss the management of complete response to neoadjuvant chemoradiotherapy in patients with mid??low rectal cancer. Methods:From 1997 to 2007,69 patients with stage 3 or 4 rectal cancer had preoperative radiotherapy by a total dose of 50 Gy (2Gy×25),concomitant with or without 5??FU/leucovorin??based preoperative chemotherapy.Radical surgery lasted 4~6 weeks after radiation by the rule of TME. Results:Two out of 69 patients, who had clinical complete response and refused to receive surgery,had local relapse and distant metastasis. In the rest 67 patients who underwent surgery,pathologic studies showed pT0N0M0 in 7 patients,which resulted in a pathological complete response rate of 10??15%.There were no recurrences or disease progression in their 12~38 months of postoperative follow??up. Conclusion:It should be cautious to make decision for patients with clinic complete response after neoadjuvant radiochemotherapy.These patients should be suggested to receive further radical surgery before much more evidence-based results had been carried out.