局部晚期直肠癌术前与术后放化疗对比研究

目的 比较术前及术后放化疗在局部晚期直肠癌患者的治疗效果.方法 回顾性分析贵州省人民医院2011-2016年收治的76例局部晚期直肠癌患者临床资料.其中,术前放化疗加手术治疗共30例(A组),5例同步放化疗期间联合贝伐单抗靶向治疗;术后辅助放化疗46例(B组).A、B两组患者均采用适形调强放疗技术(IMRT),靶区中位剂量50.4 Gy(45.0～55.8 Gy),中位放疗次数26次(24～28次),放疗日口服卡培他滨片825 mg/m2,每天2次.比较两组患者的临床资料和随访结果.结果 A、B两组患者5年无瘤生存率分别为66.7％、57.7％,5年总生存率分别为81.8％、73.0％,差异均无统计学意义(P=0.599、0.489).肿瘤位于腹膜反折以下保肛率分别为56.52％、25.00％,差异有统计学意义(P=0.045).A组患者术前临床分期与术后病理分期比较,总降期率86.6％,病理学完全缓解3例.结论 局部晚期直肠癌患者行术前放化疗可使肿瘤降期,一定程度上提高保肛率及局控率,而术后并发症发生率并未增加.术前放化疗联合贝伐单抗靶向治疗可能提高患者降期效果.

Comparison of the therapeutic effect of preoperative and postoperative chemoradiotherapy for locally advanced rectal cancer

Objective To compare the therapeutic effect of preoperative chemoradiotherapy or postoperative adjutant chemoradiotherapy for locally advanced rectal cancer.Methods The clinical data of 76 patients with locally advanced rectal cancer from 2011 to 2016 in Guizhou Provincial People's Hospital were retrospectively analysed.A total of 30 cases received preoperative chemoradiotherapy (group A),5 of them received concurrent chemoradiotherapy combined with bevacizumab target treatment.The other 46 cases (group B) were given post-operative adjutant chemoradiotherapy.Both group A and group B were treated with intensity-modulated radiation therapy (IMRT).The chemoradiotherapy regime was as follows:the median of target volume dose was 50.4 Gy (45.0-55.8 Gy);the median of chemotherapy sessions was 26 times (24-28 times).Capecitabine tablets (825 mg/m2,twice a day) were also given on the date of chemotherapy.The clinical data and follow-up results of all patients were compared between the two groups.Results The five-year disease free survival rates of group A and group B were 66.7％ and 57.7％,respectively;and the five-year overall survival rates of group A and group B were 81.8％ and 73.0％,respectively,no statistically significant difference was found between the two groups (P=0.599,0.489).The anus-preserving rates of patients with tumor below peritoneal reflection in group A and group B were 56.52％ and 25.00％,there was statistically significant difference (P=0.045).In the group A,86.6 ％ patients resulted in down-staging,including 3 cases with complete pathologic response.Conclusion Preoperative chemotherapy could down tumor stage and improve rates of anal preservation and local control without increasing possibility of postoperative complications.Preoperative chemotherapy in combination with bevacizumab target treatment may be more effective in lowering tumor stage.