局部进展期直肠癌术前新辅助治疗疗效分析

摘要

目的 观察术前同期放化疗或术前单纯放疗在T3、T4期或影像学淋巴结阳性直肠癌患者治疗中的疗效和安全性.方法 回顾分析2000 -2009年收治的141例局部进展期或影像学淋巴结阳性的直肠癌患者资料,其中术前同期放化疗97例,术前单纯放疗44例.放疗采用二维或三维技术,化疗采用4种方案.结果 随访率为91.5％,随访满3、5年者分别为106、68例.降期率达59.0％ (82/139),保肛手术率达65.5％ (91/139).3、5年总生存率分别为85.8％、65.7％,局部复发率分别为9.2％、14.1％,转移率分别为33.8％、45.8％.术前同期放化疗患者中位无瘤生存期优于术前单纯放疗(51:31个月,x2=12.88,P=0.000).肿瘤降期患者在远处转移时间上迟于未降期患者(60:29个月,x2=14.65,P=0.000).急性不良反应多为1、2级,伤口愈合延迟及吻合口瘘发生率低.结论 术前同期放化疗或术前单纯放疗能明显降低肿瘤分期、提高手术保肛率,不良反应小且绝大多数患者可耐受.%Objective To observe the efficacy and safety of preoperative concurrent chemoradiotherapy or radiotherapy alone in patients with T3,T4 or lymph node-positive rectal cancer.Methods 141 rectal cancer patients with locally advanced or node-positive based on imaging from 2000 to 2009 were retrospective analyzed.Ninety-seven patients received preoperative concurrent chemoradiotherapy and 44 received preoperative radiotherapy alone.Two-dimensional or three-dimensional radiation technique and four types of chemotherapy regimens were used.Results The following-up rate was 91.5％.106 patients were followed up for at least 3 years and 68 patients for at least 5 years.The 3-and 5-year overall survival rates were 85.8％ and 65.7％,respectively.The 3-and 5-year local recurrence rates were 9.2％ and 14.1％,respectively.The 3-and 5-year metastasis rates were 33.8％ and 45.8％,respectively.The downstaging rate was up to 59.0％ (82/139) and the rate of sphincter preservation was 65.5％ (91/139).The median disease-free survival in patients treated with preoperative concurrent chemoradiotherapy was superior to radiotherapy alone (51 months vs 31 months,x2 =12.88,P =0.000).The time to metastasis in patients with downstaging was significantly delayed than that in patients without downstaging (60 months vs 29 months,x2 =14.65,P =0.000).Most acute toxicity was grade 1 and grade 2.The incidence of delayed wound healing and anastomotic leakage was very low.Conclusions Preoperative concurrent chemoradiotherapy or radiotherapy alone has excellent tumor downstaging effect and helps in sphincter preservation,with tolerable side effects.