Clinical Study Of Neoadjuvant Radiotherapy And Chemotherapy For Locally Advanced Rectal Cancer

Objective:To evaluate the efficacy and perioperative complications of neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer（LARC）Methods:A retrospective analysis was made on 113 patients with locally advanced rectal cancer who received neoadjuvant radiotherapy and chemotherapy in our hospital from 2012 to 2020.Preoperative radiotherapy was performed with simultaneous integrated dose SIB-IMRT（simultaneous integrated boost intensity-modulated radiation therapy）.The total dose of 95%PTV was 50～60Gy,1.8～2.14Gy each time,5 times a week,and the total course of treatment was 5～6weeks.All patients received concurrent chemotherapy with capecitabine,among which 58 patients underwent radical resection of rectal cancer at an interval of 6～12weeks after radiotherapy and chemotherapy.Over survival（OS）,disease-free survival（DFS）and metastasis-free survival（MFS）were calculated by Kaplan-Meier method.Results:Fifty-eight patients were operated according to TME principle.The rate of anus-preserving operation was 60.3%（35/58）,R0 resection rate was 98.3%（57/58）,T decline rate was 46.6%（27/58）,N decline rate was 53.4%（31/58）,and TN total decline rate was 72.The median follow-up time was 34 months,and the 3-year OS,DFS and MFS were 81.4%,84.7%and 87.9%,and the 5-year OS,DFS and MFS were 73.2%,77.6%and 81.2%,respectively.Two patients（3.4%）had recurrence and seven patients（12.1%）had distant metastasis.The 3-year survival rates of yp0-II and yp III-IV were 84.9%and 68.2%,and the 5-year survival rates were 70.8%and 45.5%,respectively.The incidence of postoperative complications was 24.1%（14/58）.Intraoperative pelvic and intestinal edema occurred in 10 cases（17.2%）,anastomotic leakage in 2 cases（3.4%）,incision infection in 7 cases（12.1%）and intestinal obstruction in 1 case（1.7%）.Conclusion:The preoperative SIB-IMRT combined with capecitabine can significantly reduce the stage and obtain a better 5-year survival rate,and the long-term survival effect of patients in yp0,yp I and yp II stages is better.Neoadjuvant radiotherapy and chemotherapy can improve the R₀resection rate and anus-preserving rate of LARC,and the treatment-related adverse reactions are mild.It does not increase the incidence of perioperative complications and does not affect the implementation of surgery.