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目的探讨新辅助治疗对低位局部进展期直肠癌的临床治疗价值。方法对35例低位局部进展期直肠癌患者,采用新辅助治疗方案。常规分割放疗,放疗总剂量DT:46Gy,每次2Gy,每周5次。全身化疗2个疗程,每次予以奥沙利铂130mg/m2,第1天静脉点滴;甲酰四氢叶酸钙(CF)200mg/m2,第1～3天静脉点滴;氟尿嘧啶(5-FU)500mg/m2,第1～3天静脉点滴。治疗结束后4～6周进行手术。结果经新辅助治疗后,病理完全缓解7例,肿瘤平均缩小34.4%,65.7%的病例T分期下降,淋巴结阴转率为55.6%。根治切除34例,其中腹会阴联合切除18例,保肛手术16例,保肛率为45.7%。姑息性Hartmann术1例。随访至今,肝转移2例,根治切除术后无1例局部复发。保肛患者肛门功能良好。结论对低位局部进展期直肠癌患者采用新辅助治疗,可使肿瘤分期降低,提高手术切除率和保肛率。
Objective To investigate the clinical value of neoadjuvant therapy in the treatment of locally advanced rectal cancer. Methods A total of 35 patients with locally advanced rectal cancer underwent neoadjuvant therapy. Conventional radiotherapy, radiotherapy total dose DT: 46Gy, each 2Gy, 5 times a week. Systemic chemotherapy 2 courses, each with oxaliplatin 130mg / m2, intravenous drip on the first day; leucovorin (CF) 200mg / m2, intravenous drip 1 to 3 days; 5-fluorouracil (5-FU) 500mg / m2, 1 to 3 days intravenous drip. 4 to 6 weeks after the end of surgery for surgery. Results After neoadjuvant therapy, pathological complete remission in 7 cases, the average tumor reduction of 34.4%, 65.7% of cases T staging decreased, lymph node negative conversion rate of 55.6%. Radical resection in 34 cases, including abdominal perineal resection in 18 cases, anus surgery in 16 cases, anus rate was 45.7%. One case of palliative Hartmann’s surgery. Follow-up so far, liver metastases in 2 cases, radical resection without a case of local recurrence. Anus patient anal function is good. Conclusions Neo-adjuvant therapy for patients with locally advanced low-grade rectal cancer can reduce the tumor stage and improve the rate of resection and anal sphincter preservation.