中低位Ⅱ/Ⅲ期直腸癌術前輔助同步放化療的效果分析

張杰+郭媛+閆旭升+賈建新

[摘要] 目的 比較中低位Ⅱ/Ⅲ期直腸癌患者術前輔助同步放化療與常規根治術的臨床療效和不良反應，為中低位Ⅱ/Ⅲ期直腸癌臨床治療方案提供參考。 方法 選取2011年12月～2013年12月在我院治療的80例中低位Ⅱ/Ⅲ期直腸癌患者，分為實驗組與對照組（n=40）。實驗組術前輔助同步放化療，對照組行常規根治術，兩組均術后按需實施放化療。術前輔助放療劑量為45～50 Gy，分次劑量為1.8～2.0 Gy/d，5 d/周；放療期間同時進行化療（采用FOLFOX 4方案），在放療的第1～4 天和第15～19 天，給予5-Fu 400 mg/m2、亞葉酸鈣200 mg/m2和草酸鉑85 mg/m2持續靜脈滴入。化療共2個周期，每周期治療時間2周。 結果 實驗組完全緩解率（CR）及客觀有效率（CR+PR）均明顯高于對照組（P<0.01）；與對照組相比，實驗組保肛率明顯增加（P<0.01），2年內局部復發率降低（P<0.01）；實驗組未增加腸梗阻、吻合口瘺與傷口延遲愈合的發生率（P>0.05）；實驗組患者總生存率較對照組延長（P<0.01）。 結論 中低位Ⅱ/Ⅲ期直腸癌患者術前輔助同步放化療提高治療效率和保肛率，降低術后復發率，改善直腸癌患者術后的生活質量。

[關鍵詞] 中低位直腸癌；Ⅱ/Ⅲ期；術前同步放化療；術后生活質量

[中圖分類號] R735.37 [文獻標識碼] B [文章編號] 1673-9701（2017）07-0071-04

[Abstract] Objective To compare the clinical efficacy and side effects of adjuvant concurrent chemoradiotherapy and conventional radical resection before the surgery of stage Ⅱ/Ⅲ low and middle rectal cancer， and to provide reference for the treatment protocol of stage Ⅱ/Ⅲ middle and low rectal cancer. Methods 80 patients with stage Ⅱ/Ⅲ middle and low rectal cancer who were treated in our hospital from December 2011 to December 2013 selected. They were divided into the experiment group and the control group（n=40）. The experimental group was given preoperative adjuvant concurrent chemoradiotherapy， and the control group was given conventional radical resection. Both groups were treated with radiotherapy and chemotherapy according to their needs after the surgery. The dose of preoperative radiotherapy was 45-50 Gy and the dose was 1.8-2.0 Gy/d， 5 d/w； Chemotherapy was performed concurrently during radiotherapy（using FOLFOX 4 protocol）. 400 mg/m2 5-Fu， 200 mg/m2 leucovorin and 85 mg/m2 oxaliplatin were administered intravenously on days 1-4 and days 15-19 of radiotherapy. Chemotherapy was 2 cycles， with the treatment time of 2 weeks in each cycle. Results The complete remission rate（CR） and objective effective rate（CR+PR） in the experimental group were significantly higher than those in the control group（P<0.01）； compared with the control group， the rate of sphincter preservation was significantly increased in the experimental group（P<0.05） and the local recurrence rate within 2 years was decreased（P<0.01）； the incidence rates of intestinal obstruction， anastomotic fistula and delayed healing of wounds were not increased in the experimental group（P>0.05）. The overall survival rate in the experimental group was longer than that in the control group（P<0.01）. Conclusion Adjuvant concurrent chemotherapy and radiotherapy before the surgery of stage Ⅱ/Ⅲ middle and lower rectal cancer improves the efficiency of treatment and the rate of sphincter preservation， reduces the postoperative recurrence rate and improves the postoperative quality of life after the surgery of rectal cancer.