直肠癌Miles术后放化疗同步与单纯化疗效果分析

目的探讨Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,予同步放化疗和单纯化疗的疗效差异。方法统计临床病例132例,男69例,女63例。年龄29～71岁。肿瘤距肛门缘均在5cm以下。术后病理检查均是中低分化腺癌,肠壁和(或)系膜淋巴结见转移灶(Duke's C)。其中随机抽取78例予以术后同步放化疗,其余54例采用术后单纯化疗。手术方法:采用腹会阴联合切除术(Miles术)。化疗方案:奥沙利铂130mg/m~2d1,亚叶酸钙100mg/m~2 d1～5,氟尿嘧啶350mg/m~2 d1～5(每月1次,连续6个月)。放射治疗方法:术后放射治疗定位采用CT模拟机,应用15MVX线,1.8Gy/次,5次/周,总剂量50.4Gy。术后4周内,放射治疗与第一个疗程的化疗同步进行。结果①局部复发率:术后随访5年,局部复发18例,其中化疗组12例,复发率22.22%,放化疗同步组复发6例,复发率8.33%。经x~2检验有统计学差异;②远处转移:术后随访5年,远处转移65例,其中化疗组28例,转移率51.85%,放化疗同步组转移37例,转移率47.44%。经x~2检验无统计学差异;③5年生存率:术后随访5年生存53例,其中化疗组16例,生存率29.63%,放化疗同步组生存37例,生存率47.44%。经x~2检验有统计学差异。结论①Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组局部复发率明显下降;②Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组远处转移率未见差异;③Duke's C期直肠癌患者行腹会阴联合切除术(Miles术)后,同步放化疗组较单纯化疗组5年生存率有明显提高。

Efficacies of concurrent chemoradiotherapy and single chemotherapy in rectal cancer patients after Miles' operation

Objectiue To study efficacies of concurrent chemoradiotherapy and single chemotherapy in rectal cancer patients after Miles' operation.Methods Totally 132 patients with Duke's C lower rectal cancer were enrolled in our study.They were randomly divided into group A (concurrent chemoradiotherapy) and group B (chem- otherapy only).Results Local relapse was found after five-year follow-up,including 6 (8.33% ) in group A and 12 (22.22% ) (P<0.05) in group B.Distant metastasis were found in 65 patients,37 patients (47.44%) in group A and 28 patients (51.85%) in group B (P>0.05).Totally 53 patients are still alive, 37 in group A and 16 in group B.The five-year survival rate was 47.44% in group h and 29.63% in group B. The survival rate in concurrent chemoradiotherapy was dramatically improved.Conclusion Post-operational concurrent chemoradiotherapy can further reduce the local relapse rate when campared with the chemotherapy only.However post-operational concurrent chemoradiotherapy can not reduce the distant metastatic rate in con- trast with,the chemotherapy only.Post operational concurrent chemoradiotherapy can further improve the five- year survival rate in contrast with the chemotherapy only.