CAJ | 학술논문

目的观察并评价低位直肠癌术前伊立替康(CPT-11)、5氟尿嘧啶(5-FU)及联合短程放射治疗后的病理学改变及疗效,为寻找有效的新辅助治疗方案提供理论依据.方法 2002年4月至2009年4月山西省肿瘤医院41例低位直肠癌患者在术前行CPT-11、5-FU及联合短程放射治疗.伊立替康组18例,伊立替康联合短程放疗组23例.观察两组患者治疗前后的病理改变,比较两种治疗方法的差异.结果两组患者在显微镜下均出现不同程度的肿瘤细胞变性、坏死;CT显示伊立替康组肿瘤与治疗前相比平均缩小33.1%(直径13.5 mm比20.2 mm),伊立替康联合短程放疗组肿瘤平均缩小34.4%(直径12.8 mm比19.5 mm).按直肠癌消退分级(RCRG)伊立替康组和伊立替康联合短程放疗组的例数分别为:1级7例和18例,2级4例和3例,3级7例和2例(均P＜0.05).两组3级癌细胞死亡、间质纤维化、血管内膜增厚的比例分别为:7例和17例,6例和17例,3例和14例(均P＜0.05).伊立替康联合短程放疗组中有5例患者达到了病理学完全缓解.结论 CPT-11、5-FU可以作为直肠癌的新辅助治疗药物,两种药物结合短程放射治疗疗效更好.
목적 관찰병평개저위직장암술전이립체강(CPT-11)、5불뇨밀정(5-FU)급연합단정방사치료후적병이학개변급료효,위심조유효적신보조치료방안제공이론의거.방법 2002년4월지2009년4월산서성종류의원41례저위직장암환자재술전행CPT-11、5-FU급연합단정방사치료.이립체강조18례,이립체강연합단정방료조23례.관찰량조환자치료전후적병리개변,비교량충치료방법적차이.결과 량조환자재현미경하균출현불동정도적종류세포변성、배사;CT현시이립체강조종류여치료전상비평균축소33.1%(직경13.5 mm비20.2 mm),이립체강연합단정방료조종류평균축소34.4%(직경12.8 mm비19.5 mm).안직장암소퇴분급(RCRG)이립체강조화이립체강연합단정방료조적례수분별위:1급7례화18례,2급4례화3례,3급7례화2례(균P＜0.05).량조3급암세포사망、간질섬유화、혈관내막증후적비례분별위:7례화17례,6례화17례,3례화14례(균P＜0.05).이립체강연합단정방료조중유5례환자체도료병이학완전완해.결론 CPT-11、5-FU가이작위직장암적신보조치료약물,량충약물결합단정방사치료료효경호.
Objective To observe and evaluate the pathologic changes and curative effects of irinotecan (CPT-11 ), 5-fluorouracil (5-FU) and combined short-term radiotherapy before low-set rectal cancer operation so as to provide a theoretic basis for formulating a new effective adjuvant therapeutic regimen. Methods A total of 41 patients of low rectal cancer were treated with CPT-11,5-FU therapy or CPT-11 plus 5-FU combined short-term radiotherapy from April 2002 to April 2009. They were divided into 2 groups according to different treatment schemes, including irinotecan group (n = 18) and irinotecan combined short-term radiotherapy group (n = 23 ). The pathologic changes before and after treatment were observed and the differences of two treatment approaches compared. Results Tumor cells had different degrees of degeneration and necrosis under microscope in two groups. Compared with computed tomographic findings before therapy, tumor sizes of two groups were reduced by an average of 33.1% ( 13.5 mm vs 20. 2mm) and 34. 4% (12. 8 mm vs 19.5 mm) respectively. Two groups were graded according to the RCRG (rectal cancer regression grade)score: RCRG1: 7 cases vs 18 cases, RCRG2:4 cases vs 3 cases and RCRG3:7 cases vs 2 cases. According to the pathologic evaluation standard, 3-degree necrosis, cell interstitial fibrosis and intimal thickening in vessels were observed in two groups: 7 cases vs 17 cases, 6 cases vs 17 cases and 3 cases vs 14 cases respectively ( all P ＜ 0. 05). Five patients achieved complete pathological remission in the irinotecan combined short-term radiotherapy group. Conclusion Based on the pathological changes and mitigation results after treatment, CPT-11 and 5-FU may be used as neoadjuvant drugs for rectal cancer. If the above two drugs can be used in combination with short-term radiation, the curative effect will be better.