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目的通过对中低位进展期直肠癌患者采用术前新辅助治疗后再行手术治疗,观察其疾病缓解、肿瘤分期的变化。方法本组收集山西省肿瘤医院肛肠外科2005年12月～2009年2月术前新辅助治疗的中低位直肠癌患者36例,男性20例,女性16例,中位年龄48岁(35～65岁),经影像学及结肠镜检查证实病变为T3或T4期直肠中下段腺癌。全部患者术前均接受以奥沙利铂+氟尿嘧啶方案化疗和局部放疗。结果 36例患者完成术前放化疗后,通过直肠指诊、腹部影像学、结肠镜及病理切片检查,发现9例(25%)患者肿瘤病灶消失,其中4例(11.1%)为临床完全缓解,5例(13.9%)为病理完全缓解,24例(66.7%)肿瘤部分缩小;2例病情稳定;1例疾病进展。术后T0期5例(13.9%),T1期6例(16.7%),T2期8例(22.2%),T3期13例(36.1%),T4期4例(11.1%)。新辅助治疗后T分期与治疗前T3期16例(44.4%)、T4期20例(55.6%)比较,肿瘤明显降期,经χ2检验,差异显著p<0.01。结论术前经新辅助治疗对于局部进展期中低位直肠癌患者肿瘤降期明显;临床和病理缓解率增加。
Objective To observe the changes of disease remission and tumor staging by using preoperative neoadjuvant therapy before and after surgical treatment of low and advanced advanced rectal cancer patients. Methods Totally 36 patients with low or medium rectal cancer who underwent neoadjuvant therapy from December 2005 to February 2009 in Shanxi Provincial Tumor Hospital were enrolled in the study. They were 20 males and 16 females, with a median age of 48 years (35-65 years Years old), confirmed by imaging and colonoscopy lesions T3 or T4 of the lower rectal adenocarcinoma. All patients were treated with oxaliplatin + fluorouracil chemotherapy and local radiotherapy before operation. Results After the completion of preoperative chemoradiotherapy, 36 patients (9% (25%) had disappeared tumor lesions by digital rectal examination, abdominal imaging, colonoscopy and pathological examination. Among them, 4 patients (11.1%) had complete clinical remission , 5 cases (13.9%) were pathologically complete remission, 24 cases (66.7%) partially reduced the tumor; 2 cases were stable; 1 case of disease progression. There were 5 cases (13.9%) in T1, 6 cases (16.7%) in T1, 8 cases (22.2%) in T2, 13 cases (36.1%) in T3 and 4 cases (11.1%) in T4. T stage after neoadjuvant therapy was significantly lower than that of 16 cases (44.4%) before T3 and 20 cases (55.6%) during T4. The difference was significant (p <0.01) by χ2 test. Conclusions Neoadjuvant therapy before surgery for locally advanced low rectal cancer patients with significant decline in clinical; clinical and pathological remission rate increased.