The Clinical Analysis Between Preoperative Chemoradiotherapy With Stage Ⅱ And Ⅲ Of Mid-low Rectal Cancer

Objective:To evaluate the efficiency and safety between preoperative concurren t chemoradiotherapy and surgery with stageⅡand Ⅲ of mid-low rectal cancer patie nts.Methods:The clinical data of 678 patients with stageⅡand Ⅲ of mid-low rectal cancer treated at the Affiliated Tumor Hospital of Xinjiang Medical University fro m January 2008 to December 2014,including 181 cases of preoperative concurrent chemoradiotherapy,497 cases of surgery alone, are collected retrospectively.Thepreo perative concurrent chemoradiotherapy group uses dimensional intensity to modulate radiation therapy(IMRT) or conformal radiation therapy 50Gy/25f/35 f,and chemoth erapy uses three kinds of solutions to divide them into group XELOX plus Radiot herapy、FOLFOX4 plus Radiotherapy and Cap plus Radiotherapy.The preoperative c oncurrent chemoradiotherapy group and surgery groups both uses TME.Results:181cases had radical surgery.The rate of sphincter preservation was 60.77%(110/181),an d there are significant differences when compared with surgery(x2=40.1, P=0.000).19 cases had no tumor cells in pathology(pathologic complete response,pCR),pCR rat e was 10.5%(19/181),the rates of pathological down-staging for the primary tumor,1ymph node and TNM stage has significant differences when compared with surgery(x2=17.08, P=0.000;x2=90.88, P=0.000;x2=62.98, P=0.000).The adervise reactionsalmo st was stage1to3,were myelosuppression,gastrointestinal reactions and radiationderm atitis, radiation cystitis,the cumulative incidence of 40.33%(73/181),no grade 4 adv erse reactions occur after 4 to 6 week of rest underwent surgery, more common p ostoperative complications were anastomotic fistula, intestinal obstruction, infection and delayed wound healing, There were no difference in the incidence of postope rative complications between the two groups(x2=0.93, P=0.583).The 5 OS inpreoperative chemoradiotherapy group was 63.9% which was significantly higher than tho se in surgery group(x2 =70.65,P=0.000).local recurrence(Disease free survival,DFS) a nd distant metastasesrate(Distanct metastasis rate,DMR)were significant difference i n two groups(x2=1.07, P=0.000;x2=91.46, P=0.000).The 5 OS of three groups were 78.38%, 58.70% and 68.35% respectively, and there were significant differenc es in three groups,The 5 OS of XELOX was higher than FOLFOX4 and Cap(x2=6.84,P=0.009).Conclusion:When compared with surgery,preoperative concurrent che motherapy can reduce the stage of tumor,it was56.3%, increase the rate of sphinct er preservation surgery,ti was higher than only surgery 6.7%,reduce local recurrence and distant metastasis rate and improve the survival of patient’s.The adervise react ions almost was stage 1to3, the postoperative complications had no increase.In the group of preoperative concurrent chemotherapy, there were no difference among 1year OS and 3year OS,but the 5 year OS of group XELOX was higher than gro up FOLFOX4 and group Cap.