Clinical Observation Of Short-term Curative Effect And Related Side Effects Of Radical Resection Combined With Intraoperative Radiotherapy In Local Intermediate And Advanced Rectal Cancer

Aims:Explore the short-term curative effect and related side effects of intraoperative photon therapeutic apparatus Intrabeam intraoperative radiotherapy system in local intermediate and advanced rectal cancer,and provide experience for intraoperative and postoperative treatment.Methods and materials:The clinical data of 54 patients with advanced rectal cancer from August 2015 to February 2017 in our hospital were retrospectively collected.The control group(rectal cancer radical operation combined with postoperative adjuvant chemotherapy)and observation group(rectal cancer radical operation,intraoperative radiotherapy combined with postoperative adjuvant chemotherapy)were 27 cases of each group.Treatment plan: the control group underwent radical resection(14cases of Dixon,12 cases Miles,1 cases of Hartmann)postoperative adjuvant chemotherapy(12 cases of capecitabine / gimeracil and oteracil potassium combined with oxaliplatin or not),the observation group underwent radical resection of rectal cancer(15 cases,Dixon Miles 11 cases,Hartmann 1 cases),intraoperative radiotherapy(50KV X-ray 10~20Gy)and postoperative adjuvant chemotherapy(12 cases of capecitabine / gimeracil and oteracil potassium combined with oxaliplatin or not).After complete treatment,regular follow-up visits were conducted every 3~6 months.The clinical efficacy,perioperative and postoperative adverse reactions were observed in this study.Results:After 17 months(16.7 months in control group,the observation group 17.1months)median follow-up,Control group: 5 cases of pelvic recurrence,4 cases of death,1 cases of new pulmonary metastasis;observation group: no recurrence,2cases of death,1 cases of new lung metastasis,1 cases of liver metastasis.The total survival rate,distant metastasis rate,1 year local control rate in the observation group and the control group was 85.2% vs 92.6%(P = 0.665),96.7% vs 96.0%(P= 1),80.8% vs 100%(P = 0.023),only the P <0.05 for the local control rate of one year,with statistical significance.The observation group exteneded the operation time by 134 min,the indwelling catheter and the recovery time of intestinal peristalsis prolonged 1 day,the length of stay dalayed 3 days compared with the control group,the other,such as Intraoperative hemorrhage and infection,Postoperative anastomotic fistula,anemia,incision infection,delayed healing,stitching time had no significant difference compared with single operation.Conclusion:For local intermediate and advanced rectal cancer,the intraoperative radiotherapy system of Intrabeam is safe and feasible.Radical resection of rectal cancer combined with intraoperative radiotherapy is better than simple operation at the same time in the treatment of locally advanced rectal cancer,and the effect is more significant for those with positive pelvic lymph nodes.