目的 探讨直肠癌手术前热疗配合同期放化疗的临床疗效及术后病理改变的特点.方法 对76例局部进展期直肠癌患者进行了手术前热疗加同期放化疗.局部热疗采用和佳HG-2000高频热疗机,放疗前1小时内完成,每周2次,放疗方式为盆腔前后对穿照射,每天2Gy,每周5次连续放疗,总剂最46Gy.在放疗开始后的第1周和第5周,同期予以四氢叶酸+5-FU全身化疗2周期.术前辅助治疗完成后4～6周实施手术.结果 T复查肿瘤的直径平均缩小36%,其中8例(11%)术后达到病理完全缓解,另外54例(71%)达到PR,癌细胞坏死率≥50%,总有效率达82%.术前综合治疗后淋巴结阳性率由68%降至45%.术后病理检杏所有肿瘤组织,均见不同程度的癌细胞变性、细胞结构破坏、肿瘤血管破坏、出血及大片凝同性坏死.瘢痕区域可见灶性钙化、再生上皮.结论 前热疗配合同期放化疗可以使直肠肿瘤缩小、减少局部淋巴结转移率,部分病例可以获得病理完全缓解.%Objective To assess the clinical effect of the combined therapy with preopera-tive regional hyperthermia,radiation and systematic chemotherapy in the management for locally advanced rectal cancer and its histopathological characteristic after the treatment.Methods 76 cases with locally advanced adenocarcinoma of the rectum entered this study.Hyperthermia using the HG-2000 was given twice a week while radiotherapy which was delivered with a total dose of 46Gy.Chemotherapy was administrated in two cycles with folinic acid and 5-FU ,and Surgery followed 4 to 6 weeks after preoperative treatment.Results Tumor lesions shrinked 36% in diameter in average.8 cases of the patients(11%) had a complete pathological response and 54 patients(71 %) had a partial pathological response (pathological response rate ≥ 50%).The percentage of lymph node metastasis in all cases was decreased from 68% to 45%.Conclusions A complete or partial pathological response.shrinkage of the primary tumors and decrease of the lymph node metastasis and down stage of the tumors were observed after preoperative treatment.
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