直肠癌新辅助放化疗的近期疗效研究

目的 探讨局部晚期直肠癌行新辅助放化疗的近期疗效.方法 对收治的30例经病理证实的局部晚期直肠癌患者行放射治疗:盆腔淋巴引流区放疗剂量45 Gy/25次之后缩野至肿瘤区加量至总剂量为50.4 Gy/28次.同步化疗方案为奥沙利铂联合卡培他滨(希罗达),同步放化疗结束后4-6周进行手术,术后完成围手术期6月的FOLFOX6方案全身化疗.结果 经治疗后肿瘤降期率60.0％(18/30).术后完全缓解率(CR)23.3％ (7/30),部分缓解率(PR)60.0％ (18/30)；稳定(SD) 16.7％ (5/30);总有效率(CR+PR)83.3％(25/30).不良反应主要为恶心呕吐、畏食、乏力、白细胞和血小板减少、腹泻、口腔炎等,无4度不良反应发生,无放化疗相关死亡.总体保肛率26.7％(8/30),本组无手术死亡.结论 直肠癌术前放化疗能提高肿瘤病理完全缓解率,降低肿瘤分期,提高手术切除率,且不良反应较轻,临床实施安全.

Short-term efficacy of neoadjuvant chemoradiotherapy in treatment of rectal cancer

Objective To evaluate the short-term efficacy of neoadjuvant chemoradiotherapy（CRT） in locally advanced rectal cancer.Methods Thirty patients with locally advanced rectal cancer underwent preoperative CRT,followed by surgical resection 4-6 weeks later.The radiation regimen consisted of pelvic lymph node area 45 Gy/25 fractions followed by additional dose to tumor with the total dose of 50.4 Gy/28 fractions.Concurrent chemotherapy regimen was oxaliplatin and Xeloda.FOLFOX6 chemotherapy protocol was given perioperatively for 6 months.Results The down-staging rate was 60.0%（18/30） after CRT.Seven patients（23.3%） achieved a pathological complete remission（pCR）.The partial remission（PR） was 60.0%（18/30）,stable disease（SD） 16.7%（5/30） with a total response rate（CR ＋ PR） of 83.3%（25/30）.The main adverse reactions were nausea and vomiting,anorexia,myelosuppression,diarrhea and stomatitis.No CRT related death and grade 4 toxicity were observed.The sphincter preservation rate was 26.7%（8/30）,no surgical mortality was seen in these patients.Conclusion Neoadjuvant chemoratiotherapy brings tumor downstaging and increases complete pathological response,resectability in locally advanced rectal cancer with acceptable adverse reactions.