摘要
目的:评估口服卡培他滨与放疗联合治疗局部进展低位直肠癌的疗效.方法:按临床分期属T_3/T_4、距肛缘3-7 cm、无远处转移或侵犯肛管的局部进展期低位直肠癌病例给予卡培他滨1250mg/m^2·d,分2次po和盆腔放射总剂量40-46 Gy,每次2 Gy.放疗结束后休息6-8 wk,按TME操作原则进行根治性切除术,在休息期间继续服用卡培他滨直至手术.结果:本研究共105例,13例临床肿瘤完全消退,未手术予以随访.92例进行根治性切除术(RO)包括直肠前切除71例,Parks’结肠肛管吻合术17例和腹会阴切除术4例,实际保留肛门括约功能者101例(96.19%).病理上11例肿瘤完全消退,加上临床肿瘤完全消退,肿瘤完全消退率(CR)达到22.86%,未见疾病进展(PD).按Dworak’s肿瘤消退分级(TRG),TRG 05例,TRG118例,TRG211例,TRG347例和TRG424例.病理有效率或降期(TGR2+3+4)为78.09%.全部病例获得随访,中位随访39(16-67)mo.局部复发4例(3.81%),肺转移4例和肝转移2例,远处转移率5.71%,总复发率9.52%.3年无病生存(DFS)82.81%,总生存(OS)96.16%.3级毒副反应仅见于手足综合征2例(1.9%).结论:采用卡培他滨的新辅助放化疗是高度有效和安全的.通过术前卡培他滨与放射联合,绝大多数肿瘤降期包括完全消退(TGR4)和中度消退(TGR3+2),使DFS和OS增高,同时术前放化疗又明显增加了切除率和保肛手术率,并提高了局部控制和长期生存,疗效确切.
AIM： To evaluate the efficacy of preoperative oral capecitabine combined with radiation （RT） on locally advanced low rectal cancer.
METHODS： Patients with T3/T4 tumors located 3 to 7 cm from the anal verge, without distant metastases or extension to the anal canal, were stratified according to clinical staging and subjected to oral capecitabine 1250 mg/（m2· d） ＋ pelvic radiation 40-46 Gy at 2 Gy per day. Surgery was carried out 6-8 weeks following completion the radiation, under the rule of TME for curative resection, and oral capecitabine was taken persistently during the interval leading up to surgery.
RESULTS： One hundred and five patients were enrolled in this study. Thirteen patients showed a clinical complete response and were followed up without surgery. Ninety two patients received curative （RO） resection, including low anterior resections in 71 cases. Parks＇ coloanal anastomosis was performed in 17 cases and abdominoperineal excision was in 4 cases, with an overall sphincter preservation in 101 patients （96.19%）. Pathologically, 11 patients showed a complete response plus clinical complete response, with an overall complete response rate of 22.86%. There was no disease progression. According to Dworak＇s tumor regression grading, there were 5 cases of TGR0, 18 of TGR1, 11 of TGR2, 46 of TGR3 and 24 of TGR4. The pathologic response rate （TGR2 ＋ 3 ＋ 4 ） or downstaging occurred in 78.09% of patients. All patients were followed up with a median follow-up time of 39 months （16-67 months）. Local recurrence occurred in 4 patients （3.81%）, lung metastases in 4 patients and liver metastases in 2 patients, with a distant metastatic rate of 5.71% and overall recurrence rate of 9.52%. The disease-free survival （DFS） was 82.81% and overall survival （OS） was 96.16%. Grade 3 toxicities occurred only, in 2 cases （1.9%） of hand-foot syndome.
CONCLUSION： Preoperative radiochemotherapy with capecitabine is highly effective and safe, and the results from this study are extremely encouraging. Downstaging occurred in this series, including complete （TGR4） and intermediate pathologic responses （TGR2 ＋ 3）, resulting in improved DFS and OS after preoperative capecitabine combined with radiotherapy, meanwhile preoperative radiochemotherapy significantly increased curative resectability and sphincter preservation, with an apparent improvement in local control and overall long term survival.
出处
《世界华人消化杂志》
CAS
北大核心
2007年第32期3446-3450,共5页
World Chinese Journal of Digestology
基金
上海市卫生局重点课题资助项目
No.99ZD-11003
关键词
直肠癌
新辅助放化疗
肿瘤降期
Rectal cancer
Neoadjuvant radioche- motherapy
Down-staging
