| Objective:To study the advanced low rectal cancer patients after receiving neoadjuvant therapy in the treatment effect and practical value of the scheme.Methods:IVSelected 32 cases study on 2012/7-2013/12 in a hospital of shandong university,shanxi medical university accept advanced low rectal cancer patients in general surgery, for preoperative confirmed by colonoscopy for advanced colorectal cancer, through a variety of imaging examination(such as CT, MRI or TRUS) confirmed.To eliminate lung, bone,liver, distant metastasis, such as line of X-ray, CT, bone scan and B chao deng auxiliary examination.There’re a total of 19 patients with male, 13 cases of women.Age range: 33 to72 years old, determine the median age of 54.4 years.Over 1 week after surgery,radiotherapy edema organization will increase the difficulty of the surgery, the tumor has not been sufficiently narrow, drop down period is not obvious, preserved anus rate impact.Eight weeks of chemotherapy and radiotherapy, although can be effectively reduced tumor size in patients with sensitive, achieve the result of drop down period, but long waiting time for operation, may cause tissue fibrosis caused by radiation and chemotherapy,increase the risk of surgery, also easy to cause the spread of cancer cells.Based on risk consideration, the author decided to adopt give two cycle folfox6 preoperative neoadjuvant chemotherapy regimens, preoperative radiotherapy scheme using 25 Gy / 5 f/w, 1 or 5consecutive days in a week, radiation dose every day for 5 Gy, rest two days, to perform a cycle again, irradiation area, besides should try to reduce the anus illuminate the rest as the primary lesion and pelvic lymph drainage area three-dimensional conformal radiationtherapy should be adopted to ensure adequate light, the preoperative neoadjuvant therapy during the implementation, nutrition support treatment, closely observe any adverse reactions occur, if necessary, can be appropriately to protect liver, acid suppression drugs.4-6 weeks after the completion of the chemotherapy for surgical treatment, pay close attention to the clinical treatment effect, after the analysis of the significance.Results:The use of neoadjuvant therapy, can make the different levels of decline in TNM staging tumor, through the comparison and imaging examination results, records before and after neoadjuvant therapy of tumor diameter and mass from the change of anal edge distance of tumor from anal edge length from an average(5.10±1.40) cm up to(6.45±1.60) cm(differences are statistically significant, P < 0.05);Lump size at a certain extent,the largest diameter from the previous average(4.6±1.40) is reduced to an average cm(2.8± 1.20) cm(difference was statistically significant, P < 0.05);Implementation after neoadjuvant therapy, laboratory examination of serum CEA values before chemotherapy(46.5 ± 17.2) ng/ml to chemotherapy(21.4 ± 11.2) ng/ml(difference was statistically significant, P < 0.05).In all the research object, based on principles of TME for all who are developing into surgery, using Dixon has 27 patients, the surgical procedure using Miles operation method of five patients, 84.38% of patients achieved the purpose of protect anal.All patients with postoperative pathologic results: four patients to TRG4 TRG3 for grade 9 patients, 8 patients TRG2 level, TRG1 for level 5 patients, 6 patients TRG0 level.Tumor pathological fade can appear in about 81.25% of patients receiving neoadjuvant therapy.All the test cases, one patient after neoadjuvant therapy, make originally the celiac and mesenteric, liver widespread metastasis cancer by imaging review and significantly decrease under the actual operation.A pelvic neoplasm in patients with pelvic use after neoadjuvant therapy produce obvious gap, for the implementation of the operation.All patients received preoperative neoadjuvant therapy can treat tolerance, all the records of neoadjuvant therapy adverse reaction is mainly embodied in the digestive system, common to varying degrees of nausea, vomiting, diarrhea, blood system canappear the most serious problem is that the problem such as bone marrow suppression.Died of neoadjuvant therapy or treatment to none occurred after the surgery was performed.Patients with postoperative incision infection in 1 case, until the end of the statistics, there is no patients with anastomotic fistula, and so and so forth.Conclusions:Preoperative neoadjuvant treatment application, can be used as an effective method to lower advanced rectal cancer treatment, can achieve significantly reduced tumor TNM stage, enhance the anal rate and reduce tumor local recurrence, the purpose of the colorectal cancer treatment, will be based on the development of new chemotherapy drugs out of the constant progress and neoadjuvant therapy.Although some scholars put forward new adjuvant therapy on postoperative recurrence and survival rate is no difference with the traditional surgery, but the author thinks that, the scholars in the proposed not clear classification, staging, and specific treatment, cancer is to use single preoperative radiotherapy of adenocarcinoma, is probably one of the reasons causing the effect not beautiful.Despite all the related studies have shown that preoperative neoadjuvant therapy is helpful for the operation and improve survival of anal rate, and many other advantages,but at the same time it should be noted that colorectal cancer for some extreme resistance to chemotherapy drugs.Due to individual differences in patients with, is not sensitive to avoid delay surgical timing, although neoadjuvant therapy can make local tumor fall period,but due to the delayed surgery, it may increase the risk of distant metastases, or side effects,need more departments, more joint preoperative diagnosis technology, so the new adjuvant therapy, there are some limitations and applicability for setting indiidualized treatment for each patient and should not blindly use.Though neoadjuvant therapy is not perfect, but there is no denying the fact that it is a effective way for the treatment of rectal cancer. |
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