Clinical Application And Curative Efficacy Analysis Of Neoadjuvant Chemoradiotherapy In Patients With Stage â…¡ And â…¢ Middle And Lower Rectal Cancer

Objective:To evaluate the clinical curative efficacy of neoadjuvant chemoradiotherapy in patients with stage â…¡ and â…¢ middle and lower rectal carcinoma by calculating the tumor size, the distance between the distal margin of the tumor and the anal verge, TNM stage, rate of anal preservationMaterials and Methods:The clinical data of 41 patients with stage â…¡ and â…¢ middle and lower rectal carcinoma (stage â…¡:7 case, cT3-4N0M0; stage â…¢: 34 cases, CT1-4N1-2M0) who received neoadjuvant chemoradiotherapy in our hospital from January 2012 to January 2015 were collected. All patients received neoadjuvant chemoradiotherapy based on a small dose long-course radiotherapy regimen. Varian LINAC linear accelerator was employed to perform 6 MV X ray multifield radiation (dosage:45-50 Gy for 25-28 times, lasting for about 5 weeks). Oral capecitabine was administered in a dose of 1700-2000mg/m2/d since the first course radiation treatment. After the completion of neoadjuvant chemoradiotherapy, preoperative MRI examination of pelvic cavity was conducted for patients with rectal cancer again to identify the local change of tumor and change of peripheral lymph gland and re-determine the clinical stages. Patients rested for 6 to 8 weeks after neoadjuvant chemoradiotherapy and received all kinds of examinations to rule out contraindications before undergoing TEM. In terms of changes in tumor size, distance from inferior tumor to anal verge, TNM staging, rate of anal preservation, patients with rectal carcinoma before and after neoadjuvant chemoradiotherapy were compared to analyze the clinical curative effect of neoadjuvant chemoradiotherapy in stage â…¡ and â…¢ middle and lower rectal carcinoma.Results:The average of the maximum rectal tumor diameters before neoadjuvant chemoradiotherapy was 6.4cm, while that after neoadjuvant chemoradiotherapy was 4.2 cm, with a mean decrease of 2.2cm. The average the distance between the distal margin of the tumor and the anal verge before neoadjuvant chemoradiotherapy was 5.2cm, while that was 6.2cm after neoadjuvant chemoradiotherapy, with a mean retraction of 1cm.15 cases underwent Dixon operation, and 3 of them underwent prophylactic ileostomy; 3 cases underwent Miles operation; 3 cases underwent Hartmann operation. The number of TNM down-staging in all patients is 24, accounting for 58.5%. Stage T3 drop to stage T2 for 6 cases, stage T3 to stage TO for 2 cases, stage T4 to stage T3 for 7 cases. The number of T down-staging is 15, accounting for 36.5%. The number of N down-staging is 14, accounting for 40%.Conclusion:Neoadjuvant chemoradiotherapy can shrink rectal tumor, increase the distance from inferior tumor to canal verge, result in down-staging and improve the rate of anal preservation. Therefore, it is one of the ideal adjuvant measures for the treatment of stage II and III middle and lower rectal carcinoma.