Neoadjuvant chemoradiotherapy combined with TME in treatment for locally advanced low rectal cancer (LALRC)

摘要

To explore the possibility of further improvement of efficacy with neoadjuvant chemoradiotherapy (NCR) in combination with TME technique in treatment for LAIRC.Methods 60 patients with T3 and T4 low rectal cancer were treated by preoperative radiotherapy to pelvis,2.0 Gy daily up to 40～46 Gy in 4 weeks concomintantly with oral capecitabine (CAP) at 1250 mg/m2 bid for 14 days every 3 weeks in group A or CAP625 mg/m2 bid continuously in group B for 10 weeks up to surgery.In all patients surgery was carried out under the rule of TME technique.Results NCR has been completed in all patients uneventfully,among them,9 patients have resulted in complete tumor response (CR),ie disappear of the lesion,so surgery was given up and the remaining 51 patients were carried out with curative resection.49 patients with SSR and 2 with APR.So overall sphincter preservation was achieved in 96.67%.In pathological findings,17 patients (28.33%) showed complete regression (CR),T2N0 in 11,T3N0 19,T 2-3 N1 13 and no cases of T4 lesion.All patients were followed up from 6～38 months with median of 24 months,no death,no local recurrence occurred and 2 suffered from lung metastasis but still alive with an overall recurrence rate of 3.33%,both disease free survival (DFS) and recurrence free survival were 96.67%.The adverse effects of chemoradiotherapy were mild,only 2 episodes of GⅢ in hand-foot syndrome.Conclusion NCR combined with TME have showed its high efficacy in tumor down-staging,shrinkage of tumor mass,increase of resectability and sphincter preservation,and improvement in long term survival,and its adverse events were mild and well tolerated.Hence it may be a new concept and way to treat a patient with LALRC.9 refs,1 tab.