CAJ | 학술논문

目的探讨卡培他滨联合放疗同步治疗中低位局部晚期直肠癌的有效性.方法回顾分析我院2009年1月至2012年12月收治的36例行术前放化疗的Ⅱ～Ⅲ期直肠癌(T3～4/N+)病人.术前放疗量1.8～2.0 Gy/(25f·5w),总量45～50 Gy.放疗期间同时服用卡培他滨1650 mg/(m2·d).放化疗结束后5～8周行全直肠系膜切除术.结果治疗前临床分期:ⅡB期5例,ⅢB期22例,ⅢC期9例.经放化疗后,pCR4例,PR 21例,SD 11例.PR+CR共25例,占69.4％.手术后病理分期:0期4例,Ⅰ期5例,ⅡA期5例,ⅡB期8例,ⅢA期1例,ⅢB期6例,ⅢC期7例.23例行保肛手术,其中11例行末段回肠预防造口.出现吻合口瘘4例,吻合口瘘率17.4％.结论卡培他滨联合放疗同步治疗中低位局部晚期直肠癌可达到术前肿瘤降期,提高根治性切除率,降低肿瘤局部复发.对保肛手术,建议行末段回肠预防造口.
목적 탐토잡배타빈연합방료동보치료중저위국부만기직장암적유효성.방법 회고분석아원2009년1월지2012년12월수치적36례행술전방화료적Ⅱ～Ⅲ기직장암(T3～4/N+)병인.술전방료량1.8～2.0 Gy/(25f·5w),총량45～50 Gy.방료기간동시복용잡배타빈1650 mg/(m2·d).방화료결속후5～8주행전직장계막절제술.결과 치료전림상분기:ⅡB기5례,ⅢB기22례,ⅢC기9례.경방화료후,pCR4례,PR 21례,SD 11례.PR+CR공25례,점69.4％.수술후병리분기:0기4례,Ⅰ기5례,ⅡA기5례,ⅡB기8례,ⅢA기1례,ⅢB기6례,ⅢC기7례.23례행보항수술,기중11례행말단회장예방조구.출현문합구루4례,문합구루솔17.4％.결론 잡배타빈연합방료동보치료중저위국부만기직장암가체도술전종류강기,제고근치성절제솔,강저종류국부복발.대보항수술,건의행말단회장예방조구.
Objective To investigate the effectiveness of capecitabine combined with radiation as preoperative chemoradiotherapy (CRT) for patients with middle-lower and locally advanced rectal cancer.Methods From Jan 2009 to Dec 2012,36 patients with stage Ⅱ-Ⅲ (T3-T4/N+) rectal cancer were treated with CRT in our hospital.The dose of radiation was 1.8 ～ 2.0 Gy/(25 f · 5 w) with total dosage of 45 ～ 50 Gy.The dose of capecitabine was 1650 mg/(m2 · d) for 25 days.Total mesorectal excision surgery was performed 5 ～ 8 weeks after CRT.Results Before CRT,the patients' clinical stage classification:stage ⅡB 5 cases,Ⅲ B 22 cases,and Ⅲ C 9 cases.After CRT,4 cases achieved complete response,21 cases partial response,and 11 cases stable disease.25 cases got total objective response,with a response rate of 69.4％.The patients' pathological stage after operation:stage 0 4 cases,stage Ⅰ 5 cases,Ⅱ A 5 cases,ⅡB 8 cases,Ⅲ A 1 case,Ⅲ B 6 cases,and Ⅲ C 7 cases.Conclusions Capecitabine combined with radiotherapy as CRT are preferred treatment for patients with middle-lower and locally advanced rectal cancer.It can bring the tumor stage down and shrinkage tumor volume,improve the resection rate,and reduce recurrence.Our clinical data suggests that prophylactic ileostomy prevents anastomotic leakage following anus-preserving rectal operation.