The Clinical Study Of Neoadjuvant Therapy For Lower Rectal Cancer

Rectal cancer is one of the common malignant carcinoma ofalimentary tract,whose morbidity is rising recently.The lowerrectal cancer is under the peritoneal reflexum,which is about halfof the all the rectal cancer.The key to treat it is to protect thefunction of anal sphincter after the radical operation.To cut theprimary carcinoma completely and to make the systemiclymphatic scavenge are the content of present therapymethod.Many scholars recommend to enlarge the operationrange in order to get better result.But high recurrence rate andmetastasis rate may happen after the operation of largerrange,and the prognosis is under people's expected value.Thefacts show except operations we should make the adjuvanttherapy which mainly includes chemical and radiation therapyon the patients. To take the operation,chemical therapy andradiation therapy into together have become the hot spot ofpresent research already.The new adjuvant therapy is a new hopein many therapy ways.Using Capecitabin(Xeloda) and radiation therapy,YuBaoming treated lower rectal cancer of stage T3 and T4,and gotgood result, 73% of cases got lower clinical stage,26.07%pathological disappearance,80%.The complications of theoperation after radiation therapy are not different from those ofsimple operation.The advantages of adjuvant radiation andchemical therapy before operation are follows: ①Radiationtherapy may make cancer cells degenerate to some differentextent,fibroplasia,infiltration vanish around the cancer.Thus wecould reduce gross tumor volume, increase operation rate,andreduce the activity of cancer cells to prevent the local extensionand lymphatic metastasis originated by operation. ②Theradiation therapy before operation could kill cancer cellsmetastating into the lymph node around the primary foci,reducethe metastasis rate into the lymph node.And the blood vesselswall could thicken around the foci and tube cavity coulddiminute.Fibration and obstruction may occur,so the chances ofmetastasis could reduce. ③Radiation therapy before operationcould reduce gross tumor volume and the infiltration around thecancer.The clinical practice shows the new adjuvant therapybefore operation of patients of progressing rectal cancer locallycould lower the clinical stage.④Radiation before operationcould kill the satellite foci and inferior clinical foci,so localrecurrence rate may reduce. ⑤The new adjuvant therapy beforeoperation could raise survival rate.Many researches showradiation before operation could reduce local recurrence rate,andchemical therapy could increase the sensitivity of radiationtherapy. Thus we could control the the rectal cancer better ,makethe operation of nerve-retained or anus-retained.The life qualityand life span could increase. Recently, more and more reportsshow the general tumor disappearance rate is 25% by the newadjuvant therapy.The PCR rate is 28.33% in the localprogressive lower rectal cancer by the combination of chemicaland radiation therapy before operation,thus the activity of cancercells and the possibility of implantation locally and recurrencewere reduced.The sensitivity of tumor cells to radiation could beamplified if 5-FU was continually dripped . Rodel's researchshows they can make the cancer the complete removal on60%—80% of the patients whose survival rate is 80% and thecutting edge is safe.The stoma is safe only if the radiation dose isless than 50 Gy before operation.So the new adjuvant therapy ispayed great attention and utilized by people more and more.Butthere are defects in it.First,poison and adverse effect of thechemical drugs may affect the best condition adjustment beforeoperation,even some operations have to be postponed because ofBMD;The therapy may be delayed to some patients unsensitiveto drugs,and the disease go ahead.Some years later,people beginto think highly of the poison and adverse effects of the newadjuvant therapy.We could say confirmly that the patientssufferring from the alimentary tumors could endure the adverseeffects of the new adjuvant therapy and scheme.The operationsmay be done as schedule and the effects to the incidence of thecomplications of it are little.Few authors pose some dead casesrelated with new adjuvant therapy.We should think highly of itand summarize it.In view of reasons above,we study the value ofthe new adjuvant therapy on the lower rectal cancer by analyzingthe 63 cases operated in our hospital from January,1998 toJanuary,2005.We try to find one more perfect therapy method,toprovide a thinking way and to provide the theory and pacticefoundations to clinical therapy to the lower rectal cancer.The 63 cases were divided into two groups,new adjuvanttherapy combined with operation group and simple operationgroup.In former group,radiation and chemical therapy were usedbefore operation,4 or 6 weeks later the operation was made,andkeep the chemical therapy after it.In latter,no therapy beforeoperation and the patients were given chemical therapy afteroperation.We analyzed the apoptotic index of two groups byimmumohistochemistry.The follow-up is over 36 months ofthem.We made contrast to the adverse effects,pathologicalchanges,AI,anus-retained rate,stoma fistulae rate,localrecurrence rate and survival rate of 3 years.The results showed ingroup 1 the acute poison and adverse effects is little.The effectsis Ⅰ-Ⅱ ususlly,and no stomach, intestine skin or uropoiesissystem effects of Ⅲ-Ⅳ have happened.No patients's therapywere discontinued because of the acute effects.The new adjuvanttherapy could make the primay foci shinked,mesentery of rectumbecome fibrous degeneration,thicken and hardened;T stage wentdown in 67.74% of them.The positive rate of lymphaden wentdown from 67.74% to 35.48%.AI after operation in group 1 washigher than that before operation(P<0.01),but AI after operationin group B isn't significantly different from that beforeoperation(P>0.05).The AI after operation in two groups issignificantly different(P<0.01).31 cases in group A got thecomplete removal of operation,19 by Dixon,2 by Hartmann andthe annus-retained rate was 93.55%.14 cases operated byDixon,6 by Hartmann,3 by Mile's,9 by proximate colonstomy orileostomy,and the annus-retained is 43.75%.The stoma fistularate was 6.4% in group A and 3.1% in group B.The survival rateof 3 years was 93.55% in group A and 53.13% in group B.Theresults showed (1) The acute poison and adverse effects islittle,Ⅰ-Ⅱ ususlly,and no stomach, intestine skin or uropoiesissystem effects of Ⅲ-Ⅳ have happened.No patients's therapywere discontinued because of the acute effects.(2) The newadjuvant therapy could make the primay foci shinked,mesenteryof rectum become fibrous degeneration,thicken andhardened.(3)The new adjuvant therapy could speed the apoptosisof cancer cells.(4)The new adjuvant therapy before operationcould increase the annus-retained rate,survival rate of 3 yearsand reduce the local recurrence rate,but did not increase theincidence rate of stoma fistula.According to that there are manyadvantages of new adjuvant therapy.The advantages is more thandisadvantages.The new therapy provide a new thinkingway,theory and practice foundation to the therapy of the lowerrectal cancers.