Objective To explore the efficiency with neoadjuvant chemoradiotherapy (NCR) in combination with pelvic exenteration on locally recurrent rectal cancer. Methods Fourty-five patients with locally recurrent rectal cancer were received a new regiment of combined preoperative chemotherapy with radiotherapy. Routine fraction of radiation was given with total dose 46Gy, 2 Gy per fraction, five times a week. Patients received oxaliplation 130 mg/m (infusion) on day 1, plus leucovorin 200 mg/m and 5-Fu 500 mg/m from day 1 to day 3 every 3 weeks for total two cycles before irradiation. Pelvic exenteration was performed 4 to 6 weeks later after NCR. Results After neoadjuvant therapy , all patients underwent surgical resections with complete pathologic response in 6 patients , average tumor size decrease by 38.4%, tumor stage decrease by 68.9% . No perioperative death occurred. The R0 resection rate was 88.5% , and the postoperative complication rate was 20.0% . The overall 3 and 5 year survival rates were 80.0% and 44.4%, respectively. The 3 and 5 year survival rates were 94.6% and 52.7% respectively in 37 patients with R0 resection. Conclusion NCR combined with pelvic exenteration have showed its high efficiency in tumor down-staging, shrinkage of tumormass, increase of resectabili-ty , and improvement in long term survival. Its adverse events were mild and well tolerated. Hence it may be a new concept and way to treat a patient with locally recurrent rectal cancer.%目的:探讨新辅助放化疗联合盆腔脏器切除术在复发性直肠癌治疗中的价值.方法:对45例复发直肠癌患者采用新辅助放化疗方案治疗常规分割放疗,治疗结束后4～6周进行盆腔脏器切除手术.结果:经新辅助放化疗后,病理完全缓解9例,肿瘤平均缩小38.4%,68.9%的病例T期下降.全组R0切除率为82.2%,手术并发症为20.0%,3年生存率为80.0%,5年生存率为44.4%.结论:新辅助放化疗联合盆腔脏器切除术是治疗复发性直肠癌的有效方法,通过降低肿瘤病期,提高手术切除率,从而提高患者生存率.
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