同期新辅助放化疗治疗局部进展期直肠癌的疗效分析

摘要

Objective To research and investigate curative effect by concomitant neoadjuvant chemoradiotherapy in the treatment of locally advanced rectal cancer. Methods A total of 100 locally advanced rectal cancer patients all received concomitant neoadjuvant chemoradiotherapy for treatment, and then they received operation according to individual condition. Comparison was made on tumor diameter, staging, toxic and side effects of chemoradiotherapy before and after treatment, and anal preservation rate after operation. Results After concomitant neoadjuvant chemoradiotherapy for 100 patients, their tumor diameter was lower as (2.84±1.65) cm than (4.65±1.55) cm before treatment, and their difference had statistical significance (t=8.00, P<0.01). These patients had better tumor staging (0 case in T0, 0 case in T1, 0 case in T2, 40 cases in T3 and 60 cases in T4) after concomitant neoadjuvant chemoradiotherapy than those (16 cases in T0, 20 cases in T1, 28 case in T2, 20 cases in T3 and 16 cases in T4) before treatment, and the difference had statistical significance (U=3.54, P<0.01). There was no death case due to chemoradiotherapy-induced toxic and side effects. Gastrointestinal reactions occurred in 8 cases with few toxic and side effects. There were 44 cases (44%) received intraoperative anal preservation treatment, and no death case during operation. Conclusion Implement of concomitant neoadjuvant chemoradiotherapy for locally advanced rectal cancer before operation can effective reduce tumor diameter and volume, improve staging and anal preservation rate, along with curative effect, prognosis and postoperative quality of life in patients. Low toxic and side effects of this method are verified, and it is worth clinical promotion.%目的：研究探讨同期新辅助放化疗治疗局部进展期直肠癌的疗效。方法100例局部进展期直肠癌患者,均进行同期新辅助放化疗治疗,再根据情况进行相应的手术治疗,比较患者新辅助放化疗治疗前后肿瘤的直径、分期,放化疗毒副作用以及术后保肛率。结果100例患者同期新辅助放化疗后肿瘤直径(2.84±1.65)cm 小于同期新辅助放化疗前的(4.65±1.55)cm,差异具有统计学意义(t=8.00, P<0.01)。患者同期新辅助放化疗后肿瘤分期情况(T0期0例, T1期0例, T2期0例, T3期40例, T4期60例)优于同期新辅助放化疗前(T0期16例, T1期20例, T2期28例, T3期20例, T4期16例),差异具有统计学意义(U=3.54, P<0.01)。无因放化疗毒副作用而死亡的患者；8例患者出现胃肠道反应,其毒副作用较小。术中44例(44%)患者实行保肛治疗,术中无死亡情况出现。结论局部进展期直肠癌在手术治疗前进行同期新辅助放化疗治疗,能有效减小肿瘤直径,从而缩小肿瘤体积,有效改善肿瘤分期,提高保肛率,有效提高患者治疗效果、预后以及术后的生活质量,经验证,其毒副作用较小,值得在临床上推广。