| Background and purpose:Currently,rectal cancer is a very common malignant tumor in clinical treatment at home and abroad.Relevant surveys and studies show that in China,the incidence of rectal cancer is increasing year by year,and at the same time,a large part of the patients have developed into local advance stage when they go to the hospital.After the development of science and technology and the progress of medical technology,nowadays,neoadjuvant chemoradiation joint TME surgery has to increase the rate of surgical resection,p CR,at the same time reduces local disease recurrence and distant metastasis rate,so it has become the preferred scheme for treatment of patients with locally advanced rectal cancer.The main failure of local advanced rectal cancer was the distant metastasis,andtotal Neoadjuvant Therapy(TNT)is currently being studied internationally,that is,6 cycles of neoadjuvant chemotherapy are added in the surgical interval after long-term neoadjuvant chemoradiotherapy.In this study,based on a long-term neoadjuvant chemoradiation surgery in our hospital,we add 2 cycle XELOX regimen neoadjuvant chemotherapy in locally advanced rectal cancer patients to determine whether the addition of two cycles of neoadjuvant chemotherapy can improve the short-term clinical efficacy and long-term prognosis of patients,so as to provide more reference for the personalized treatment of patients with this disease.Materials and Methods:Retrospective summary in July 2016 to March 2020 in our hospital for long-term neoadjuvant chemoradiotherapy of the clinical data of 52 patients with locally advanced rectal cancer,including surgery interval to add 2 cycle neoadjuvant chemotherapy group with 23 cases(44.2%),not to join the neoadjuvant chemotherapy has 29 cases(55.8%),the total dose radiation therapy of 52 patients for 46-50 Gy,Gy2/f,1 f/day,5 times a week,and all of the patients at the time of radiation therapy need toconcrurrent capecitabine chemotherapy(825 mg/m~2,2/day,5 days a week,radiation therapy,oral);At the same time,6 cycles of chemotherapy were made up after surgery.Postoperative pathological sections should be staged according to the AJCC staging criteria of the eighth edition.The degree of tumor regression in patients needs to be evaluated according to the Dworak grading;Patients’adverse reactions to radiotherapy were assessed according to the RTOG acute radiation injury classification criteria and the RTOG/EORTC advanced radiation injury classification scheme.In addition,in this study,for the results obtained from the analysis of clinical data of patients,SPSS software was used to statistically analyze the factors affecting TRG,Kaplan-Meier method was used to analyze OS and DFS,and survival curves were drawn and compared with Log-rank test.Multivariate analysis was carried out by Cox model,P<0.05 indicates that the difference is statistically significant.Results:(1)Among the 23 patients with preoperative neoadjuvant chemotherapy,there were 8 and 17 patients with T descending stage and 22 patients with T descending stage and 22 patients with 29 patients who did not receive neoadjuvant chemotherapy,respectively.Chi-square test results showed no statistical significance(P>0.05).Univariate analysis plus neoadjuvant chemotherapy was not associated with tumor TRG grade(P>0.05).(2)Of the 23 patients with preoperative neoadjuvant chemotherapy,18 patients received the anal preservation,and 21 patients in the 29 who did not receive neoadjuvant chemotherapy.Chi-square test results showed no statistical significance(P>0.05).(3)The 2-year OS,DFS and local recurrence rates of the group with neoadjuvant chemotherapy and the group without chemotherapy were 90.9%and 100%,86.2%and84.2%,8.7%and 3.4%,8.7%and 17.2%,respectively.Log Rank analysis showed no statistically significant difference(P>0.05).(4)The results of rank sum test showed that the operation interval plus or without chemotherapy had no effect on the side effects of acute and advanced radiotherapy.(5)Univariate analysis showed a significant correlation between postoperative T,N stage and tumor TRG grade(P<0.05),the earlier the yp T staging,the higher the TRG and the greater the degree of tumor regression in patients with negative postoperative lymph nodes.Conclusions:1.The addition of 2 cycles of XELOX regimen neoadjuvant chemotherapy at the surgical interval after long-term neoadjuvant chemoradiotherapy for rectal cancer had no effect on the T-drop stage,N-drop stage and tumor regression grade.2.The addition of 2 cycles of XELOX regimen neoadjuvant chemotherapy in the surgical interval after long-term neoadjuvant chemoradiotherapy for rectal cancer had no effect on the surgical method and the anal preservation rate.3.Adding 2 cycles of XELOX regimen neoadjuvant chemotherapy after long-term neoadjuvant chemoradiotherapy for rectal cancer has no effect on OS,DFS,local recurrence rate and distant metastasis rate.4.The addition of 2 cycles of XELOX regimen neoadjuvant chemotherapy in the surgical interval after long-term neoadjuvant chemoradiotherapy for rectal cancer did not increase radiotherapy side effects.In conclusion,under the premise of 6 cycles of chemotherapy,the addition or absence of 2 cycles of neoadjuvant chemotherapy at the surgical interval after long-term neoadjuvant chemoradiotherapy for rectal cancer has no effect on the treatment and prognosis.5.Postoperative T stage and N stage are both effective factors affecting the grade of tumor regression.The earlier yp T stage is,the higher yp N(-)is,the greater the degree of tumor regression is. |
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