Effect Of Neoadjuvant Therapy In Treatment For Advanced Rectal Cancer

[Methods]A total of 25 advanced rectal cancer patients were first treated with preoperative chemoradiotherapy. Patients received radiotherapy five times a week at a dose 2Gy, daily up to 50Gy in five weeks. Concomitantly patients received continuous venous chemotherapy with OXA (65mg/m~2 /d, ivgtt, d1,2) and Oral 5-Fu (Doxifluridine Capsules 400mg po.tid or Tegafur 200mg po.tid) . Operations(TME) were performed 6-8 weeks after neoadjuvant therapy. Before the operation patients received additonal preoperative chemotherapy with FOLFOX4 regimen for 2 cycles. The follow-up were arranged every 3 months after surgery. Patients received adjuvant chemotherapy with FOLFOX4 regimen.We collected the clinical and pathological informations and compared the results with the group in which patients received surgery without neoadjuvant therapy.[Results]After neoadjuvant therapy, no patients had grade III or IV acute toxicity. All side effects were mild and well tolerated.After neoadjuvant therapy, the tumor became smaller and more movable. Postoperative pathology examinations of specimens revealed tumor tissue necrosis, paratumor infiltration disappearance, paratumor lymph node necrosis and blood vessel occlusion. Cancers shrank from a mean diameter of 5.92cm to 2.48cm, down size rate was 58.1%. 5 patients(20%) were found no cancer cells after surgery , reached pathological complete remisson.The resection rates were 100% in the ncoadjvant group and 84% in the surgery group respectively, there was significant differences between the two groups(p<0.05).The rates of sphincter preservation were 50% in the neoadjvant group and 16.7% in the surgery group respectively, there was significant differences between the two groups(p<0.05).The risk rates of perineal incisional infection was 44.4% in the neoadjvant group and 0% in the surgery group respectively, there was significant differences between the two groups(p<0.05).The rates of local recurrence were 12% in the neoadjvant group and 32% in the surgery group respectively, there was no significant differences between the two groups(p>0.05).[ Conclusion ]Neoadjuvant therapy in advanced rectal cancer patients showed an efficacy in down-staging, in increase of resectability and sphincter preservation. The side effects were mild and well tolerated. Patients dealing with Miles operations suffered more risks in infection of perineal incisional wound after noeadjuvant radiotherapy.