低位局部晚期直肠癌的新辅助治疗

目的：研究低位局部晚期直肠癌的术前新辅助治疗的意义.方法：2002年2月至2006年6月间共有局部晚期低位直肠癌患者45例,在我院接受术前新辅助放、化疗,然后进行手术治疗.化疗方案：奥沙利铂＋甲酰四氢叶酸钙＋氟尿嘧啶,与放疗同步化疗二个周期;放疗方案：1.8Gy/次,每周5次,共25次,5周内完成,总剂量45Gy.结果：经过术前新辅助放、化疗,多数病例手术病理标本表明肿瘤消退为TRG3（53.3%）,其中4例肿瘤完全消失;60.0%（27/45）的病例T降期,原发病灶平均最大径平均缩小35.8%;62.2%（28/45）的病例N降期.全组71.1%（32/45）的病例采用保留肛门手术,17.8%（8/45）的患者采用腹会阴联合切除术,8.9%（4/45）因肿瘤消失未行手术.结论：低位晚期直肠癌的新辅助治疗,可降低肿瘤分期,从而提高手术切除率和保肛率.

Preoperative Neoadjuvant therapy for lower local advanced rectal carcinoma

Objectlve：Studying the clinical effect of preoperative Neoadjuvant therapy in lower locally advanced rectal carcinoma. Methods 45 patients with lower locally advanced rectal carcinoma were received preoperative Neoadjuvant therapy. Patients received oxaliplatin on day 1, plus leacovorin and 5- Fu （intravenous bolus） from day 1 to day 3, every ：3 weeks for total two cycles. Radiotherapy was given with total dose of 45Cy, 5 times per week, 1 .SGy in each fraction. Operation was performed 4 to 6 weeks later after chemoradiotherapy. Results After Preoperative neoadjuvant therapy, Pathological examination showed 53.3% cases were in TRG3 tumor regression grade and complete pathologic response in 4 patients. Tumor stage decreased in 60.0% （27/45）, the average max diameter of tumor decreased 35.8 %. Nodal stage decreased in 62.2% （28/45） of patients. 71.1% （32/45） cases received sphincter - preserving surgery and 17.8 % （8/45） cases received abdominoperineal resection. 8.9 % （4/45） cases didn＇t received operation because of tumor disappear after preoperative neeadjuvant therapy. Conclusion Combined preoperative neoadjuvant therapy with surgery is a better therapy for lower advanced rectal cancer, which can decrease tumor stage, therefore improve respectability and anal sphincter preservation rate.