【摘要】 目的:探讨局部晚期直肠癌术前同期放化疗后临床及病理降期情况及其相关影响因素。方法:回顾性分析30例行术前同期放化疗的局部晚期直肠癌患者的临床资料,放疗采取三维适形放疗技术,同期化疗为奥沙利铂与卡培他滨联合方案。评价其术前临床及术后病理降期效果并分析相关影响因素。结果:术前临床评价T分期降期率达73.3%(22/30),17例N+患者10例淋巴结完全消退;术后病理发现,14例患者T分期下降,降期率为46.7%,其中5例患者达pCR,完全缓解率为16.7%(5/30)。单因素分析显示,放疗后继续服用卡培他滨及放疗至手术间歇期长者肿瘤降期率高。除1例放疗期间出现膀胱瘘者,仅1例出现Ⅲ级造血系统毒副反应,未见Ⅳ级毒副反应。结论:局部晚期直肠癌术前同期放化疗耐受性良好,有效率高,更加合理的同期化疗需更进一步的临床试验证实。更多还原

【Abstract】 OBJECTIVE:To observe the clinical and pathological down-staging for locally advanced rectal cancer treated with preoperative concurrent chemo-radiotherapy, and evaluate clinical factors correlated with pathology response. METHODS: A total of 30 patients of locally advanced rectal cancer treated with preoperative concurrent chemo-radiotherapy were analyzed retrospectively. All patients received 3D conformal radiotherapy, the concurrent chemotherapy regimen was Oxaliplatin combined with Capecitabine. RESULTS: The clinical and pathological down-staging rates of T stage were 73.3%(22/30)and 46.7%(14/30), respectively. Ten patients got complete remission in 17 N+ patients. Five patients achieved pCR after preoperative chemo-radiotherapy with a pCR rate of 16.7%. Univariate analysis showed that Capecitabine used continually after radiotherapy and the prolongation of interval period between radiotherapy and surgery could bring a higher down-staging rate. There were 1 patient with vesical fistula, 1 patient with Ⅲ degree hematopoietic system side effect, and no Ⅳ degree toxicity in all 30 patients. CONCLUSIONS: Preoperative concurrent chemoradiotherapy is well tolerated for locally advanced rectal cancer. The optimal chemotherapy needs more clinical investigation to confirm.更多还原