• 首都醫(yī)科大學(xué)宣武醫(yī)院普外科（北京 100053）;

目的 　分析術(shù)前放化療結(jié)合全直腸系膜切除術(shù)（TME）治療低位進(jìn)展期直腸癌的療效。
方法 　回顧性分析筆者所在醫(yī)院2009年1月至2011年12月期間行術(shù)前放化療聯(lián)合TME的31例低位進(jìn)展期直腸癌患者的臨床資料。放療采用常規(guī)分割放療，總劑量50Gy/25f；化療采用mFOLFOX6或CapeOX方案。臨床-病理對照記錄療效，并評價(jià)保肛患者的肛門功能。
結(jié)果 　全部患者均接受TME手術(shù)治療，手術(shù)并發(fā)癥發(fā)生率為12.9% （4/31），死亡率為3.2% （1/31）。經(jīng)術(shù)前放化療，腫瘤直徑平均縮小21.9%；48.4% （15/31）的患者出現(xiàn)T分期下降，陽性淋巴結(jié)患者比例由83.9% （26/31）降至38.7% （12/31），5例（16.1%）患者獲得病理學(xué)完全緩解，總有效率達(dá)74.2% （23/31）；Ⅲ～Ⅳ度不良反應(yīng)發(fā)生率為6.5% （2/31），保肛患者肛門功能良好率達(dá)84.6% （22/26）。
結(jié)論 　從本組有限的病例看，對低位進(jìn)展期直腸癌采用術(shù)前放化療結(jié)合TME手術(shù)能夠達(dá)到部分腫瘤的病理學(xué)完全緩解，縮小原發(fā)腫瘤，降低局部淋巴結(jié)轉(zhuǎn)移率，從而達(dá)到降低腫瘤分期、提高手術(shù)療效的目的。

引用本文： 李昂,曹鋒,方育,李嘉,張鈺鵬,劉殿剛,李非. 術(shù)前放化療結(jié)合全直腸系膜切除在低位進(jìn)展期直腸癌治療中的應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(9): 971-974. doi: 復(fù)制

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2. Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma[J]. Ann Surg， 2007， 246(5)：693-701.
3. Gérard JP， Conroy T， Bonnetain F， et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers：results of FFCD 9203[J]. J Clin Oncol， 2006， 24(28)：4620-4625.
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6. Eisenhauer EA， Therasse P， Bogaerts J， et al. New response evaluation criteria in solid tumours：revised RECIST guideline (version 1.1)[J]. Eur J Cancer， 2009， 45(2)：228-247.
7. Dworak O， Keilholz L， Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy[J]. Int J Colorectal Dis， 1997， 12(1)：19-23.
8. Williams NS， Patel J， George RD， et al. Development of an electrically stimulated neoanal sphincter[J]. Lancet， 1991， 338(8776)：1166-1169.
9. Ortholan C， Francois E， Thomas O， et al. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer：evidence from randomized trials[J]. Dis Colon Rectum， 2006， 49(3)：302-310.
10. Enríquez-Navascués JM， Borda N， Lizerazu A， et al. Patternsof local recurrence in rectal cancer after a multidisciplinaryapproach[J]. World J Gastroenterol， 2011， 17(13)：1674-1684.
11. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Gudielines in Oncology——Rectal Cancer. http：//www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
12. 肖毅. 直腸癌新輔助治療[J]. 中國普外基礎(chǔ)與臨床雜志， 2010， 17(9)：906-909.
13. Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921[J]. J Clin Oncol， 2005， 23(24)：5620-5627.
14. 于波， 金偉森， 李世擁， 等. T3期中低位直腸癌同步放化療后行保肛手術(shù)的臨床研究[J]. 結(jié)直腸肛門外科， 2009， 15(4)：221-223.
15. 柴宇嘯， 曲興龍， 王奕靜， 等. 同步新輔助放化療聯(lián)合全直腸系膜切除術(shù)治療中低位局部進(jìn)展期直腸癌的臨床研究[J]. 腫瘤， 2011， 31(7)：658-661.
16. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer[J]. N Engl J Med， 1997， 336：980-987.
17. Birgisson H， Påhlman L， Gunnarsson U， et al. Adverse effects of preoperative radiation therapy for rectal cancer：long-term follow-up of the Swedish Rectal Cancer Trial[J]. J Clin Oncol， 2005， 23(34)：8697-8705.
18. Sebag-Montefiore D， Stephens RJ， Steele R， et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)：a multicentre， randomised trial[J]. Lancet， 2009， 373(9666)：811-820.
19. Stephens RJ， Thompson LC， Quirke P， et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial[J]. J Clin Oncol， 2010， 28(27)：4233-4239.
20. Sauer R， Liersch T， Merkel S， et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer：results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J]. J Clin Oncol， 2012， 30(16)：1926-1933.
21. Roh MS， Yothers GA， O’Conneu MJ， et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum：NSABP R-04 [J]. J Clin Oncol， 2011， 29(Suppl)：abstr 3503.
22. Tulchinsky H， Shmueli E， Figer A， et al. An interval ＞7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally　advanced rectal cancer[J]. Ann Surg Oncol， 2008， 15(10)：2661-2667.
  1. 1. Heald RJ， Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet， 1986， 1(8496)：1479-1482.
  2. 2. Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma[J]. Ann Surg， 2007， 246(5)：693-701.
  3. 3. Gérard JP， Conroy T， Bonnetain F， et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers：results of FFCD 9203[J]. J Clin Oncol， 2006， 24(28)：4620-4625.
  4. 4. Ceelen WP， van Nieuwenhove Y， Fierens K. Preoperative chemoradiation versus radiation alone for stageⅡandⅢresectable rectal cancer[J]. Cochrane Database Syst Rev， 2009(1)：CD06041.
  5. 5. Bosset JF， Collette L， Calais G， et al. Chemotherapy with preoperative radiotherapy in rectal cancer[J]. N Engl J Med， 2006， 355(11)：1114-1123.
  6. 6. Eisenhauer EA， Therasse P， Bogaerts J， et al. New response evaluation criteria in solid tumours：revised RECIST guideline (version 1.1)[J]. Eur J Cancer， 2009， 45(2)：228-247.
  7. 7. Dworak O， Keilholz L， Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy[J]. Int J Colorectal Dis， 1997， 12(1)：19-23.
  8. 8. Williams NS， Patel J， George RD， et al. Development of an electrically stimulated neoanal sphincter[J]. Lancet， 1991， 338(8776)：1166-1169.
  9. 9. Ortholan C， Francois E， Thomas O， et al. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer：evidence from randomized trials[J]. Dis Colon Rectum， 2006， 49(3)：302-310.
  10. 10. Enríquez-Navascués JM， Borda N， Lizerazu A， et al. Patternsof local recurrence in rectal cancer after a multidisciplinaryapproach[J]. World J Gastroenterol， 2011， 17(13)：1674-1684.
  11. 11. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Gudielines in Oncology——Rectal Cancer. http：//www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.
  12. 12. 肖毅. 直腸癌新輔助治療[J]. 中國普外基礎(chǔ)與臨床雜志， 2010， 17(9)：906-909.
  13. 13. Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921[J]. J Clin Oncol， 2005， 23(24)：5620-5627.
  14. 14. 于波， 金偉森， 李世擁， 等. T3期中低位直腸癌同步放化療后行保肛手術(shù)的臨床研究[J]. 結(jié)直腸肛門外科， 2009， 15(4)：221-223.
  15. 15. 柴宇嘯， 曲興龍， 王奕靜， 等. 同步新輔助放化療聯(lián)合全直腸系膜切除術(shù)治療中低位局部進(jìn)展期直腸癌的臨床研究[J]. 腫瘤， 2011， 31(7)：658-661.
  16. 16. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer[J]. N Engl J Med， 1997， 336：980-987.
  17. 17. Birgisson H， Påhlman L， Gunnarsson U， et al. Adverse effects of preoperative radiation therapy for rectal cancer：long-term follow-up of the Swedish Rectal Cancer Trial[J]. J Clin Oncol， 2005， 23(34)：8697-8705.
  18. 18. Sebag-Montefiore D， Stephens RJ， Steele R， et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016)：a multicentre， randomised trial[J]. Lancet， 2009， 373(9666)：811-820.
  19. 19. Stephens RJ， Thompson LC， Quirke P， et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial[J]. J Clin Oncol， 2010， 28(27)：4233-4239.
  20. 20. Sauer R， Liersch T， Merkel S， et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer：results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J]. J Clin Oncol， 2012， 30(16)：1926-1933.
  21. 21. Roh MS， Yothers GA， O’Conneu MJ， et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum：NSABP R-04 [J]. J Clin Oncol， 2011， 29(Suppl)：abstr 3503.
  22. 22. Tulchinsky H， Shmueli E， Figer A， et al. An interval ＞7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally　advanced rectal cancer[J]. Ann Surg Oncol， 2008， 15(10)：2661-2667.