| Objective: The aim of this study was to observe the clinical effectivity and safety of rectal cancer treated by preoperative chemoradiation with Tegafur, Gimeracil and Oteracil Potassium Capsules combined with dimensional conformal radiotherapy or intensity modulated radiotherapy, in order to provide individual treatment scheme. To evaluate the value of endoluminal ultrasound in stage diagnosis of rectal cancer. By check the expression of DPYD, TYMS and MTHFR, to analyze the relationships between expression levels of DPYD, TYMS, MTHFR genes with clinical effect and toxic reaction, in order to provide base for clinical treatment protocols optimizing and prognosis evaluation.Methods: 40 patients with rectal cancer in II/III stage randomly was divided into four groups A, B, C, D with 10 cases in each one. All the patients were administered with three dimensional conformal radiotherapy(3DCRT) or intensity modulated radiotherapy(IMRT)(DT50Gy/25F). From the first day of radiotherapy, Tegafur, Gimeracil and Oteracil Potassium Capsules were oral administered of 45mg/m2/d, 50mg/m2/d, 60mg/m2/d and 75mg/m2/d in A, B, C, D each group, respectively, for two cycles which including two weeks administration and one week rest. Operations were carried out after finished chemoradiation six to eight weeks. Patients in each group were given two times endosonography check before chemoradiation and operation, respectively and the curative effect and toxic reaction were evaluated and compared by stages. Stages of patients before operation were all evaluated and compared with those before chemoradiation and pathology stages after operation. The m RNA expression levels of DPYD,TYMS and MTHFR genes were detected by DNA- liquid phase chip methods, and their relations with treatment effect and toxic reactions were analyzed.Results:1 The complete remission(CR) rates were 20.0% to 30.0%, the total effective rates were 70.0% to 80.0%, and the disease control rates were 100.0% in each group after treatment(P>0.05).2 The main toxic reactions were gastrointestinal reaction and bone marrow depression. In each group, the gastrointestinal reaction with incidence rates of 70.0% to 90.0%(P>0.05), were all in I or II grade, only two cases(20.0%) were III grade in D group. The bone marrow depressions in A, B and C group were of 30.0% to 40.0%(P>0.05), all in I or II grade; But in D group, the bone marrow depressions rates were 70.0%, including one case in III grade and three cases in IV grade, significantly higher than that of other groups(P<0.05).3 The proportion of T stage, N stage and total stage were all descend 70.0% to 80.0%, 66.7% to 71.4% and 70.0% to 80.0% in four groups, respectively(P>0.05).4 All the 40 patients were operated successfully with an R0 excision rate 90.0% and a anus keep rate 69.2%.5 By endosonography, diagnosis accuracy rates were 50.0%, 66.7%, 75.0%, 83.3% and 100.0% for T0, T1, T2, T3 and T4 stage, respectively. The total diagnosis accuracy rate was 77.5% of T stage. The diagnosis accuracy rates of endosonography were 88.4% and 62.5% for N0 and N1 stage, respectively. The total diagnosis accuracy rate was 80.0% of N stage. The total diagnosis accuracy rate was 72.5% of TNM stage.6 The differences were not statistically significant between DPYD positive or negative of theirs effective rates(P>0.05). The toxic reaction incidence rate were significantly lower in DPYD positive patients than that of negative patients(P<0.05). The total effective rates were significantly lower in TYMS positive patients than that of negative patients, while the toxic reaction incidence rate were significantly higher in TYMS positive patients than that of negative patients(P<0.05). The total effective rate was significantly lower in MTHFR positive patients than that of negative patients(P<0.05). The toxic reaction incidence rates were not statistically significant in MTHFR positive or negative patients(P>0.05).Conclusions:1 Preoperative chemoradiation of Tegafur with dimensional conformal radiotherapy or intensity modulated radiotherapy in II/III stage rectal could produce clearly down stage, and improve the rates of R0 excision and funcation keep. This treatment programe has good clinical effect and safty.2 ERUS is one of the most common used detective methods in preoperative diagnose of rectal cancer. It has a good accuracy in stage diagnosis.It is also good for us to decide the operation method.3 By detecting expression level of DPYD, TYMS and MTHFR gene, maybe predict curative effect and toxic reaction initially, and select or draw up individual treatment programe. |
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