T2期低位直肠癌术前伊立替康化疗联合短程放疗后局部切除的可行性研究

目的 探讨术前伊立替康化疗联合短程放疗后局部切除术治疗T₂期低位直肠癌的可行性。方法 收集山西省肿瘤医院2002年1月至2008年8月间行术前伊立替康化疗联合短程放疗后行经肛门局部切除术（TAE）的37例低位直肠癌患者的临床资料，分析治疗疗效、不良反应及随访情况。结果 37例患者经术前治疗后4例（10.8％）获完全缓解，27例（73.0％）部分缓解，6例（16.2％）病情稳定，有效率为83.8％，疾病控制率为100.0％。37例患者术后出现肛门狭窄2例（5.4％），出血和直肠阴道瘘各1例（2.7％）。至随访截止时间，共6例（16.2％）术后出现复发转移，其中3例为局部复发，2例为肝转移，1例局部复发伴肝转移；37例患者术后的3年、5年复发率分别为11.7％、14.1％；全组患者术后生存时间为26～118个月，3例患者因转移复发死亡，术后3年、5年生存率分别为94.6％、91.4％。结论对于符合条件的T₂期低位直肠癌患者，术前伊立替康化疗联合短程放疗后局部切除治疗可以作为临床选择方案之一。

Transanal local excision of T2 low rectal cancer after irinotecan chemotherapy combined short-term radiotherapy

Objective To investigate the feasibility of transanal local excision of T2 rectal cancer after irinotecan chemothera- py combined short-term radiotherapy. Methods Thirty-seven patients with T2 rectal cancer who underwent irinotecan chemotherapy combined short-term radiotherapy followed by transanal local excision from Jan. 2002 to Aug. 2008, were reviewed. Results Under- went preoperative treatment, complete responses and partial responses were achieved in 4 （ 10. 8% ）and 27 （73.0%）patients, respec- tively. Six patients were stable disease and no one occurred disease progress. The response rate was 83.8% and disease control rate was 100.0%. Four patients underwent postoperative complications, 2 patients（5.4% ） were anal stenosis, 1 patient（2. 7% ） were bleeding and 1 patient（ 2. 7% ） were rectovaginal fistula. A total of six patients（ 16. 2% ） postoperative recurrence and metastasis ,3 pa- tient were local recurrence, 2 patients were liver metastases, l patient was local recurrence with liver metastasis. 3-, 5-year recurrence rates were 11.7% and 14. 1% , respectively. Three patients died of metastasis and recurrence. 3-, 5-year overall survival were 94. 6% and 91.4% , respectively. Conclusion For appropriate patients of T2 rectal cancer, transanal local excision after irinotecan chemother- apy combined short-term radiotherapy can be used as the clinical choice.