A Study Of Combined Treatment With Compound Tegafur Oral Chemotherapy And Radiotherapy In Recurrent Rectal Cancer

Objective:Rectal cancer is one of the common malignancy of digestive system.The preferred treatment is operative treatment,but its recurrence rate is higher,especiallyfor the patients inⅡPhase and above.Rectal cancer local recurrence rate has beendecreased obviously since Heald put forward the “Colorectal cancer radical surgery” in1982. However, the local recurrence is still a main factor for five-year survival rate anddeath rate. Most of the patients died of local recurrence rather than distant metastases.Recurrent rectal cancer patients often accompany with local sharp pain and survivalquality is reduced obviously,therefore,due attention should be paid to early diagnosisand early treatment of local recurrence of colorectal cancer in order to improve survivalquality and overall survival rate of patients. This study mainly looks into the recenttreatment results,curative effect and the untoward effect of three dimensional conformalradiation therapy (3DCRT) in recurrent rectal cancer in order to provide a new optionfor recurrent rectal cancer patients.Method:A prospectie study about recurrent rectal cancer patient in tumor hospitalof Liaoning Province from June,2009to December,2010has carried out.138cases ofrecurrent rectal cancer involved into our study，which have been divided into twogroups randomly. Compound tegafur combine radiotherapy was taken in one group.While in the other group we use single radiotherapy as the control group. All of themhave taken three dimensional conformal radiation therapy (3DCRT). S-1wasadministered to take orally on days1to14and days22to35during radiotherapy intreatment group,60mg per day, twice a day. after radiation50Gy/25f and then theGTV added amount to70Gy in the two groups of radiation does. conventionalsegmentation,2Gy/f, Five times a week，and all of them were using10MV X-ray forlinear accelerator treatment.Three months after treatment, the efficacy and adverse reaction were detected by pelvis CT.Results:The treatment group and the control group’s total effective rates (RR)were89.9%(62/69) and65.2%(45/69) respectively. There had significant difference bystatistics calculation(χ~2=12.024,P=0.001,P<0.05). The treatment group and the controlgroup’s disease control rates (DCR) were95.7%(66/69) and85.5%(59/69). There hadsignificant difference by statistics calculation(χ~2=4.161,P=0.077， P<0.05). Thetreatment group and control group’s pain relief rates were79.7%(55/69) and66.7%(46/69). To compare the two groups’ pain relief rate we found that treatment group washigher than control group but the difference was not obviously(χ~2=2.991，P=0.124,P>0.05). The hematology toxic reaction of treatment group were mainly includingleukopenia,neutropenia and anemia,while the non-hematology toxic reaction weremainly including diarrhea and tired in our study.The incidence of leukopenia was59.4%and39.1%in treament group and control group respectively,whose incidence washigher than the control group and the difference was statistically significant (χ~2=5.682，P=0.027). The incidence of neutropenia was63.7%and44.9%in treament group andcontrol group respectively,whose incidence was higher than the control group and thedifference was statistically significant(χ~2=4.936，P=0.40). The incidence of diarrhea was68.1%and47.7%in treament group and control group respectively,whose incidencewas higher than the control group and the difference was statistically significant(χ~2=5.829， P=0.025).The other adverse reaction had no statistically significantdifference. The hematology toxic reactions in grade Ⅲand above mainly includingneutropenia and anemia in treatment group. Its incidence were4.3%and7.2%respectively in our study. There is no hematology toxic reaction in grade Ⅲand abovein control group.The non-hematology toxic reactions in gtade Ⅲ and above mainlyincluding diarrhea. Its incidence was14.5%,while the control group was7.2%in ourstudy.Compared with the treatment group and control group in grade Ⅲ and above toxicreaction,although the incidence of treatment group was higher than control group,butthere was no statistically significant difference. Compound tegafur with threedimensional conformal radistion therapy has improved the treatment effect, while theadverse reactions were as follow. But its adverse reactions of grade Ⅲ/Ⅳ wereunusually, which can be relieved by timely symptomatic treatment.The treatment grouphad not handfoot syndrome,which better than Capecitabine.During the period oftreatment there was no death in the two groups which was treatment-related. Conclusion:Combined treatment with compound tegafur oral chemotherapy andradiotherapy is an effective methods which has small toxic reaction，administration wayis convenient，can be well tolerated.It is an new treatment in patients expeciallyrecurrent rectal cancer patients. Our findings suggest that combined treatment withcompound tegafur oral chemotherapy and radiotherapy is a promising regimen withbenefits in terms of safety and effectiveness when compared with single threedimensional conformal radiation therapy(3DCRT)regimens in recurrent rectal cancerpatients.But the longterm outcomes about combined treatment with Compound tegafuroral chemotherapy and radiotherapy in recurrent rectal cancer is still need large samplessurvey and further follow-up study.