| ObjectiveStudy of rectal cancer with preoperative neoadjuvant chemotherapy regimens for the treatment of tumor size changes, CEA hematology examination changes and postoperative survival rate changes, with period analysis of preoperative neoadjuvant therapy. To evaluation the effect of chemo-radio therapy before operation.MethodsFrom2006to2009in our hospital gastrointestinal surgery in patients with rectal cancer, with strict criteria for inclusion and exclusion criteria, Selection of appropriate patients for preoperative neoadjuvant chemotherapy and44cases as treatment group, random selection of staging are basically the same in patients with rectal cancer in45cases, improve the preoperative examination, radical resection of rectal cancer as compared to the control group.treatment group given FolFox chemotherapy before operation, chemotherapy treatment, a total of3days, a week off after local radiotherapy, irradiation, total dose of30Gy, divided doses (3Gy /time/day), every5days for a course of treatment, a course is completed after2days of rest for the next radiotherapy, a total of two courses, after a month again into our hospital do some blood examination, colonoscopy, abdominal CT and endorectal ultrasound examination and so on, on neoadjuvant chemotherapy, tumor size, CEA in blood and abdominal CT showed tumor peripheral changes were analyzed, based on the results of the analysis to make reasonable operation scheme, all of the patients in our hospital radical resection of rectal carcinoma, in which Mile’s in32cases, Dixon in57cases, margin negative. Postoperative all specimens were stained sections, immunohistochemical and pathological process. Postoperative continue to be conventional chemotherapy5courses of treatment, and regular follow-up, including blood tests, colonoscopy, abdominal CT. And the change in tumor size, CEA hematological changes and postoperative survival rate using the SPSS statistical software was used for statistical analysis.Results89patients were treated with surgical operation, the postoperative pathological diagnosis results for adenocarcinoma of the rectum, which tubular adenocarcinoma of49people (56.34%), papillary adenocarcinoma,6people (7.42%), nipple-tubular adenocarcinoma of30people (30.80%), mucinous adenocarcinoma of2people (2.81%), signet ring cell car cinoma2(2.81%). Through the following neoadjuvant chemoradiation, tumor volume significantly decreased in29patients (67.42%), with no changes or changes are not obvious in14cases (30.33%), the local volume increase of1patients (2.25%). The CEA value of elevated in10cases (22.73%), the normal range and the following34cases (77.27%).In82cases with follow-up,7patients lost to follow-up, follow-up time was6-36months,20patients (24.39%) died of recurrence and metastasis,19cases (23.17%),63cases (79.32%) survival. After treatment by another9patients with viable anus-preserving operation in treatment, and pathological examination of negative margins, the sphincter preserving rate increased by nearly60.8%, single factor analysis of tumor size and CEA before and after treatment with significant changes (P0.05), with statistical significance. After the treatment, tumor staging (TNM) display, primary tumor T4stage reduction in17patients (68%), T3reduced in9cases (47.37%), T2increased in26cases (59.09%), regional lymph node Nlreduction in21patients (80.77%), NOincreased in26cases (59.09%),The treatment group of lyear survival rate was97.73%, the mortality rate was2.27%, the disease-free survival rate was97.73%, the observation group lyear survival rate was84.44%, the mortality rate was15.56%, the disease-free survival rate was88.89%; the treatment group of3year survival rate was88.13%, the mortality rate was2.70%, the disease-free survival rate was88.13%, recurrence rate in2.70%, the observation group3year survival rate was68.46%, the mortality rate was 31.54%, the disease-free survival rate was66.09%, recurrence and metastasis rate was12.12%. Treatment group and observation group after treatment the survival rate had statistical significance (P<0.05).ConclusionsThe treatment of rectal cancer treated by traditional operation gradually transformed into a multidisciplinary integrated treatment mode, neoadjuvant chemotherapy has become the hot spot. Through preoperative neoadjuvant chemoradiation can not only reduce tumor volume, effect of CEA and other indicators, preoperative radiotherapy, can inhibit the growth of tumor cells, reduce the tumor size, and the effect of radiotherapy of sustainable existence for more than3months, preoperative chemotherapy, can give full play to the efficacy of drugs, so that local tumor chemotherapy drug concentration reaches a maximum, preoperative concurrent chemoradiation contribute to decreased during the treatment of adverse reactions, the best treatment outcomes, reduce to tumor staging, tumor resection rate relatively before have significantly improved, and can improve the sphincter preserving rate, improve patients’ life quality after the operation, so that after lyears,2years,3years of prolonged survival, disease-free survival rate, lower local recurrence rate, neoadjuvant chemoradiation, lower local recurrence rate, survival rate has improved significantly, but for the long term survival rate still need further research. For rectal cancer, operation is a must, but in order to better prolong postoperative survival time, line of preoperative radiotherapy and chemotherapy treatment is good, not only can make up for the lack of interaction, radiotherapy, chemotherapy and operation can make the curative effect is obviously improved, significantly prolong survival of patients with this rate, a new multidisciplinary treatment modalities for the treatment of rectal cancer with new ideas, preoperative chemotherapy combined with radiotherapy in treatment for rectal cancer operation provides good operation excision of timing and extent of resection, preoperative chemoradiation due to reduced tumor volume, is conducive to reducing the scope of operation, improve the quality of life of patients after operation, we all means are beneficial to patients overcome the tumor, while improving the quality of life of patients, and preoperative radiotherapy and chemotherapy treatment is worth us to study further. |
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