新辅助放疗在低位直肠癌中的应用

目的探讨新辅助放疗在低位局部进展期直肠癌中的疗效及其对保肛手术的意义。方法回顾性分析2000~2005年39例行新辅助放疗低位直肠癌病人的临床资料。结果肿瘤距肛缘3~7 cm,平均4.9 cm。放疗后21例(53.8%)排便困难、便血等症状得以改善。腹会阴联合切除14例,低位前切除术13例,Parks术8例,Hartm ann术4例。术后病理显示肿瘤完全消退(CR)3例,肿瘤部分缓解(PR)22例,无效(NR)14例,总有效率为64.1%(25/39)。保肛率为53.8%(21/39),其中放疗有效者(CR PR)保肛率为64%(16/25),无效者为35.7%%(5/14),两者间差异有显著性意义(P<0.01)。结论新辅助放疗对多数直肠癌病人有效,可以使肿瘤缩小、降低分期,并可提高低位直肠癌的保肛率。

Neoadjuvant radiotherapy for low rectal cancer

Objective To assess the effectiveness of neoadjuvant radiotherapy followed by surgery in locally advanced low rectal cancer.Methods The clinical data of 39 locally advanced low rectal cancer patients were analyzed retrospectively.All patients received 50 Gy for 5 weeks in 25 fractions.After an interval of 2-6 weeks,all patients were submitted to surgery under the rule of TME technique.Results All patients underwent surgery:14 abdomino-perineal resection,13 anterior resection,8 Parks operation and 4 Hartmann operation.In pathological finding,3(7.7%) patients showed complete regression(CR),the overall response rate(CR plus PR) was 64.1%(25/39).The percentage of sphincter-saving surgery in the response group was higher(64% in response group vs 35.7% in no response group,P<0.01).Conclusion In patients with locally advanced low rectal cancer,neoadjuvant radiotherapy provides shrinkage of tumor mass,down-staging and increases the percentage of sphincter-saving surgery.