Application Study Of Local Advanced Rectal Cancer With R0 Resection Combined With Intraoperative Radiotherapy

Background:Rectal cancer is one of the most common Malignancies in the world.Because there are no obvious symptoms and signs in the early stage,many patients have been locally advanced at the time of diagnosis.Patients with locally advanced rectal cancer have deep tumor infiltration and it is difficult to cure by simple operation.If just with surgical treatment alone,it easily lead to local recurrence,once local recurrence occured,tumor progression is fast,causing short survival period.the current NCCN rectal cancer guidelines recommend locally advanced rectal cancer patients to receive standard treatment program for surgery combined with preoperative or postoperative concurrent chemoradiotherapy,its staging based AJCC staging,AJCC rectal cancer staging,the definition of T3 is the range between the tumor penetrating the muscularis layer to the subserosal,the relative range is large.All patients with locally advanced rectal cancer according to this stage of radiotherapy and chemotherapy,may be overtreated,and the treatment period is long,the cost is high,and some patients have difficulty in completing all treatments.Therefore,ESMO rectal cancer guidelines further divide it into four sub-groups: a,b,c and d.Different sub-groups have different adjuvant therapies.However,this method requires higher requirements for nuclear magnetic resonance machines and medical personnel,and is difficult to popularize on a large scale.According to the pathological condition of the margin of rectal cancer during locally advanced operation,it can be divided into R0,R1 and R2.This method is simple,convenient and easy to popularize.A number of data indicate that patients with R1 and R2,external radiotherapy combined with intraoperative radiotherapy combined with external radiotherapy can significantly increase the local control rate,but for R0 patients,local boost through intraoperative radiotherapy.The rate of local control was not increased,so patients with rectal cancer R0 resection can achieve effective dose by external irradiation alone.The recurrence of rectal cancer is mostly limited to the pelvic ankle,the anastomosis,which close to the tumor bed,Intraoperative radiotherapy is a single intraoperative high dose radiotherapy for local target area.It can be given directly irradiation during the operation to the tumour bed and pelvic where is located near the tumour bed and easily to recurrence.The treatment cycle is short,biology effect is high,the type of rectal tumor is mostly adenocarcinoma,and the biological effect is higher.Therefore,for patients with locally advanced rectal cancer who cannot complete the standard treatment plan but can undergo R0 resection,intraoperative radiotherapy can be tried to improve the tumor control probability.Purpose:1.To observe the clinical effect of R0 resection combined with intraoperative radiotherapy for locally advanced rectal cancer.2.To observe whether intraoperative radiotherapy combined with TME radical operation increases the complications of surgical treatment.3.To explore the value and significance of R0 resection combined with intraoperative radiotherapy for locally advanced rectal cancer.Methods and materials:To review the clinical data of 50 patients with primary advanced rectal cancer who underwent R0 resection of rectal cancer,postoperative adjuvant chemotherapy,and no preoperative or postoperative external radiotherapy in our hospital from August 2015 to February 2017.According to whether intraoperative radiotherapy is divided into observation group and control group.Observation group: 26 patients underwent radical rectal cancer(11 Miles,14 Dixon,1 Hartmann),intraoperative radiotherapy(Intrabeam,surface dose 14-20 Gy,average 16 Gy)and postoperative adjuvant chemotherapy(capecitabine)Combined with oxaliplatin).Control group: 24 patients underwent radical resection of rectal cancer(10 Miles,13 Dixon,1 Hartmann)and postoperative adjuvant chemotherapy(capecitabine plus oxaliplatin).After the end of treatment,the patients were followed up regularly every 3 to 6 months to observe the clinical efficacy of the patients.Results:After 24 months of follow-up observation,the observation group: 1 patient died,no local recurrence,1 patient had multiple systemic metastases,and 1 patient had progression of primary liver metastases.The 2-year overall survival rate,2-year local control rate,and 2-year long-distance transfer rate were 96.2%,100%,and 96.2%,respectively.The control group: 3 patients died after local recurrence,2 patients with local recurrence and tumor survival,a total of 5 patients with local recurrence,1 patient with new lung metastasis.The 2-year overall survival rate,2-year local control rate,and 2-year long-distance transfer rate were 87.5%,79.2%,and 95.8%,respectively.Compared with the control group,the observation group prolonged the operation time by 2 hours,the urethral indwelling and intestinal peristalsis recovery time was extended by 1 day,and the hospitalization time was extended by 3 days.Others such as incision infection,postoperative anastomotic leakage,anemia and single-surgery operation were not significantly different.There was significant difference in the rate of local control between the two groups(P<0.05).There was no significant difference in the overall survival rate(P>0.05).There was no significant difference in the rate of distant metastasis(P>0.05),and the complications had no statistical significance(P > 0.05).Conclusion:1.R0 resection combined with intraoperative radiotherapy for locally Results: advanced rectal cancer can increase the local control rate,but can not improve the overall survival rate and no distant metastasis rate.2.Compared with surgery alone,surgery combined with intraoperative radiotherapy did not increase the related complications.3.For locally advanced rectal cancer patients who can not complete the standard treatment but can undergo R0 resection,intraoperative radiotherapy may be used instead of external radiotherapy.