Objective To explore the safety and efficacy of preoperative three-dimensional confor-mal radiation therapy combined -with oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX4) chemotherapy in locally advanced low-resynchronization therapy in patients -with rectal cancer. Method Analyzed the data of a total of 54 patients -with rectal cancer treated -with preoperative three-dimensional conformal radiation therapy combined with FOLFOX4 chemotherapy in parallel in the low neoadjuvant treatment of locally advanced rectal cancer retrospectively. A linear accelerator -was used for radiotherapy therapy, radiation prescription dose DT46～50 Gy/23～25F. Result The bowel problems and bloody stool and other symptoms of 46 patients (85. 19%) were improved significantly after concurrent chemotherapy. Complete remission rate was 11. 11% (6/54), tumor stage, lower rate of 64. 81% (35/54). Among the whole group, 30 cases (55. 56%) -with low anterior resection of abdominal, 24 patients (44. 44%) -with abdominal perineal resection, sphincter preservation rate -was 55. 56%; pathological complete remission rate -was 12.96% (7/54); decreasing rate of tumor stage was 72. 22% (39/54). Adverse reactions mainly appeared in digestive and blood systems, with Ⅲ rade nausea, vomiting and diarrhea and neutropenia rates were 1. 85%, 1. 85% and 9. 26%, no more than grade Ⅳ response. The median follow-up time -was 32 months, follow-up rate 98. 15%. The whole set of data showed that 1 and 3 year survival rates were 83. 7%, 76. 3%. Conclusion Preoperative three-dimensional conformal radiation therapy combined with FOLFOX4 simultaneous treatment of locally advanced rectal cancer is safe and effective, but the small number of cases in this group, observation time is shorter, long-term efficacy and toxicity needs further clinical observation.%目的 探讨术前三维适形放疗配合草酸铂联合亚叶酸钙和氟尿嘧啶(FOLFOX4)化疗方案同步治疗中低位局部晚期直肠癌的安全性和有效性.方法 对54例直肠癌患者术前三维适形放疗联合FOLFOX4化疗同步进行中低位局部晚期直肠癌新辅助治疗的资料进行回顾分析.放疗采用直线加速器进行治疗,处方剂量DT46～50 Gy/23～25 F.结果 46例(85.19%)患者在同期放化疗后排便困难及血便等症状明显改善;病理完全缓解率为11.11%(6/54),肿瘤分期降低率64.81%(35/54).全组行经腹低位前切除术30例(55.56%),腹会阴联合切除术24例(44.44%),保肛率为55.56%;病理完全缓解率为12.96%(7/54),肿瘤分期降低率72.22%(39/54).不良反应以消化系统和血液系统较为常见,其中Ⅲ级恶心、呕吐和腹泻及中性粒细胞减少发生率分别为1.85%,1.85%和9.26%,均无Ⅳ级以上反应.中位随访时间为32月,随访率98.15%;1,3年生存率分别为83.7%,76.3%.结论 术前三维适形放疗联合FOLFOX4同步治疗局部晚期直肠癌是安全有效的.
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