中低位Ⅱ/Ⅲ期直肠癌术前辅助同步放化疗的效果分析

张杰+郭媛+闫旭升+贾建新

[摘要] 目的 比較中低位Ⅱ/Ⅲ期直肠癌患者术前辅助同步放化疗与常规根治术的临床疗效和不良反应，为中低位Ⅱ/Ⅲ期直肠癌临床治疗方案提供参考。 方法 选取2011年12月～2013年12月在我院治疗的80例中低位Ⅱ/Ⅲ期直肠癌患者，分为实验组与对照组（n=40）。实验组术前辅助同步放化疗，对照组行常规根治术，两组均术后按需实施放化疗。术前辅助放疗剂量为45～50 Gy，分次剂量为1.8～2.0 Gy/d，5 d/周；放疗期间同时进行化疗（采用FOLFOX 4方案），在放疗的第1～4 天和第15～19 天，给予5-Fu 400 mg/m2、亚叶酸钙200 mg/m2和草酸铂85 mg/m2持续静脉滴入。化疗共2个周期，每周期治疗时间2周。 结果 实验组完全缓解率（CR）及客观有效率（CR+PR）均明显高于对照组（P<0.01）；与对照组相比，实验组保肛率明显增加（P<0.01），2年内局部复发率降低（P<0.01）；实验组未增加肠梗阻、吻合口瘘与伤口延迟愈合的发生率（P>0.05）；实验组患者总生存率较对照组延长（P<0.01）。 结论 中低位Ⅱ/Ⅲ期直肠癌患者术前辅助同步放化疗提高治疗效率和保肛率，降低术后复发率，改善直肠癌患者术后的生活质量。

[关键词] 中低位直肠癌；Ⅱ/Ⅲ期；术前同步放化疗；术后生活质量

[中图分类号] R735.37 [文献标识码] B [文章编号] 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.