Objective To observe the effect of preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. Methods The clinical data of 20 patients with locally advanced rectal cancer who received preoperative concurrent chemoradiotherapy from October 2010 to December 2015 in our hospital were analyzed retrospectively.All patients received a total dose of 46~50.4Gy three dimensional conformal radiation therapy (3DCRT), which were divided into 23~28 times. Meanwhile, two cycles of Capecitabine or XELOX regimen or FOLFOX regimen concurrent chemotherapy were given. Total mesorectal excision (TME) was then carried out. Resection rate, sphincter preservation rate, pathological degradation rate and remission rate , local recurrence rate , side effects of chemoradiotherapy , postoperative complications and survival were evaluated. Results Overall pathologic degradation rate was 80% (16/20) in all patients.The pathological degradation rate of moderate differentiation adenocarcinoma , cT staging, cN staging was 73.3%(11/15),80%(16/20),82.3%(14/17) respectively.Postoperative pathological complete remission (pCR) rate was 20% (4/20). Time from the completion of neoadjuvant chemoradiotheray to operation was 32 to 112 days (median 49 days).All patients achieved R0 resection, including 12 cases of Mile's resection, seven cases of Dixon's resection, one case of anterior resection. Sphincter preservation rate was 40% (8/20) in total, 100% (4/4) for tumor more than 5 cm away from anus and 25% (4/16) for tumor less than 5cm from the anus. No local recurrence was found in median follow-up time of 34 months. Distant metastasis rate was 30% (6/20), with four cases of pulmonary metastasis and two of liver metastasis. Three pathological complete remission (pCR) cases do not received adjuvant chemotherapy after surgery, and most interestingly, no recurrence and distant metastasis were found after following up for 5 years.Inhibition of hematopoietic function (1~2 level) was up to 90% (18/20) after chemoradiotherapy. Postoperative complications included intestinal adhesions 35%(7/20), delayed wound healing 10%(2/20), small bowel obstruction 5%(1/20) and intestinal fistula 5%(1/20). Conclusions Preoperative concurrent chemoradiotherapy for locally advanced rectal cancer can reduce pathological stage , increase the rate of radical resection and sphincter preservation, reduce local recurrence rate while will not increase recent toxicity and difficulty of operation. It is feasible in clinical practice and worth propagandizing.%目的：观察局部进展期直肠癌患者行术前同步放化疗的疗效。方法回顾性分析2010年10月至2015 年12月间本院收治的20例在术前接受同步放化疗的局部进展期直肠癌患者的临床资料。所有患者接受总剂量为46～50．4 Gy 三维适形放疗，分为23～28次，同时接受卡培他滨或XELOX 方案或FOLFOX 方案化疗2个周期，再行手术。评估术前放化疗患者的手术切除率、保肛率、病理降级率和缓解率、局部复发率、放化疗毒副作用、术后并发症发生情况。结果所有患者的总病理降级率为80％（16／20），其中直肠中分化腺癌、术前临床T 分期（cT）、术前临床 N 分期（cN）的病理降级率分别为73．3％（11／15）、80％（16／20）、82．3％（14／17），术后病理完全缓解（pCR）率为20％（4／20）。手术距术前放疗结束时间隔32～112天，中位间隔49天（7周）。所有患者均达到 R0切除，其中 Mile's 术12例， Dixon 术7例，直肠前切除术1 例；保肛率为40％（8／20） ，其中肿瘤下界距肛门＞5 cm 的患者保肛率为100％（4／4）；肿瘤下界距肛门≤5 cm 的患者行超低位保肛率为25％（4／16）。中位随访34个月，所有患者未见局部复发，远处转移率为30％（6／20），其中肺转移4例，肝转移2例；4例死亡，2例带瘤生存。3例病理完全缓解（pCR）的患者术后均未接受辅助化疗，随访5年无复发和远处转移。术前放化疗后骨髓造血功能抑制（1～2级）达90％（18／20）。术后并发症中肠粘连35％（7／20）、伤口延迟愈合10％（2／20）、小肠梗阻5％（1／20）、肠瘘5％（1／20）。结论局部进展期直肠癌术前同步放化疗能使病理降期，提高肿瘤根治率和保肛率，降低局部复发率，并不增加近期毒副反应和手术并发症，在临床上切实可行，值得推广。
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