Clinical Research Of Neoadjuvant Chemoradiotherapy Combined TME Surgery Acting On The Low Advanced Rectal Cancer

Objective: By means of neoadjuvant chemoradiotherapy on part positivelymph nodes of the low advanced rectal cancer with non-distant metastasis,preoperative stage T3and above,observed tumor size, tumor stage, surgicalresection and anal sphincter preservation rate changes, meanwhile analysised of its impact on survival, and comprehensive assessment of Neoadjuvantput the efficacy of chemotherapy in the treatment of advanced colorectalcancer.Methods: During March2007to March2010,93cases of patients withlow advanced rectal cancer has been taken and treated by GastrointestinalSurgery department of our hospital.All patients had clear pathologicalbiopsy-proven rectal adenocarcinoma.All the patients classified by thepreoperative basin, abdominal CT or MRI for tumor staging. T3N0M0,19cases (20.4%), T4N0M015cases (16.1%), the T2N1M05cases (5.4%),T3N1M037cases (39.8%), T4N1M017cases (18.3%). Phase II of34cases, accounting for36.6%, Phase III of59cases, accounting for63.4%.93patients were randomly divided into neoadjuvant chemoradiotherapy group (experimental group) and direct operation group (control group).Among them,47patients in the experimental group and46patients in thecontrol group.Both in age, gender, tumor size, from the anal margindistance,preoperative staging were not statistically different. Theexperimental group patients are given FOLFOX regimen Neoadjuvantchemotherapy. Chemotherapy ways to intervene in local arterial infusionchemotherapy. The specific programs are as follows: the total amount ofthe patient based on the patient’s body surface area, calculated inaccordance with the amount of oxaliplatin (130mg/㎡), superselectivecatheterization intervention to tumor blood vessels nourish (rectum artery)Oxaliplatin100mg+20ml of normal saline and tegafur injection1.0intothe implementation of the infusion chemotherapy.Then the remaining doseof oxaliplatin added5%glucose solution500ml continuous infusion in theperipheral vein, to be completed within2-6hours. Then tegafur3.0-4.0dissolved in saline120ml, micro pump control input speed continuousinfusion into the body within48hours. Tegafur during treatment,leucovorin body surface area per day200mg synchronization intravenousinfusion. At the same time, given antiemetic symptomatic drugs such asanti-allergy treatment.After2weeks of finishing Chemotherapy,it startedRadiotherapy. Irradiated with a total dose of40Gy,2Gy/times/day, thecontinuous irradiation five days week, two days of rest. Radiotherapyduring synchronization given850mg/㎡oral capecitabine twice a day, radiotherapy treatment for four weeks to complete, back to the hospital fourweeks of rest after the end of radiotherapy, again line electroniccolonoscopy, pots, abdominal and pelvic CT or MRI assess the effect of thesize of the tumor volume before and after Neo adjuvant therapy and localdown staging, and observe whether the tumor progression. After positivepreoperative preparation after surgery. Control group to improve therelevant check directly to surgery. The surgery was performed by the samethe senior titles physician of the medical group’s chief surgeon, in strictaccordance with standard of TME surgery. The pathological specimensunified censorship row section staining and immunohistochemistryprocessing, observe the the pathological specimens changes incircumstances. All patients continued FOLFOX chemotherapy. The twogroups were compared the difference in the rate of surgical resection,sphincter preservation and survival. All data were statistically analyzedusing SPSS13.0statistical software.Results: During the process of Neoadjuvant chemoradiotherapy byexperimental group,59.6%of patients with adverse reactions.most areoccurred in class I to II, only2.1%in class III. All patients aftersymptomatic treatment get smooth recovery, and complete treatment andfollow-up surgery. After Neoadjuvant therapy, the tumor volume havedifferent degrees of narrowing, and the boundaries of the tumor andsurrounding tissue or organs than Neoadjuvant before treatment becomes clearer. At the same time, it had obviously significant effect to down stageof the tumor,the rate reached to74.5%. Experimental tumor radicalresection rate was100%, while the radical resection rate was91.3%in thecontrol group. From the anal margin <6cm tumor, the experimental groupsphincter preservation rate was77.8%, control group sphincter preservationrate was19.4%, the difference was statistically significant. All patientswere not serious situation, no perioperative deaths occurred presacralvenous plexus hemorrhage, ureteral injury, anastomotic rupture. The twogroups showed no significant difference in operative time, blood loss, butthe abdomen or perineal wound infection rate of the patients of theexperimental group than the control group (P <0.05). All93cases thepatients were followed up. Experimental group after1-year the totalsurvival rate was97.85%,1-year disease free survival rate was95.70%,82.36%after1-year the total survival rate of the control group, and the1-year disease free survival rate was84.53%. After2-year the total survivalrate of the experimental group was91.18%,2-year disease free survivalrate was89.02%,73.21%after2-year the total survival rate of the controlgroup, and the2-year disease free survival rate was70.82%. Experimentalgroup after3-year the total survival rate was88.87%, the tumor-freesurvival rate was84.40%,66.24%after3-year the total survival rate of thecontrol group, the3-year disease free survival rate was61.54%.Experimental and control groups in the1-,2-, and3-year total survival rates and disease free survival rate there is a statistically significantdifference (P <0.05).Conclusions: Applying neoadjuvant chemoradiotherapy on advanced rectalcancer patients,it can reduce the tumor volume and tumor stage,increasetumor radical resection rate and low rectal sphincter preservation, reducethe local recurrence rate. Patients with preoperative chemotherapy andradiotherapy are generally well tolerated. Adverse reactions in class III areshared a low incidence. Patients1,2and3-year share a higher totalsurvival and tumor-free rate than patients with surgery alone, but itslong-term survival needs further study.