| Purpose:By contrast the tumor size, TNM stage, sphincter preservation before and after neoadjuvant chemoradiotherapy in rectal cancer, combined with the long-term prognosis and operation pathology to evaluate the efficacy of preoperative chemoradiotherapy in local advanced rectal cancer, and to research the correlation with the recurrence of CEA, CA-199, lymph node metastasis and cancer nodes.Patients and Methods:Restrospective analysis all 60 patients with resectable, locally advanced(Ⅱ/Ⅲ) adenocarcinoma of the mid-low rectum, treated with neoadjuvant chemoradiotherapy from Sir Run Run Shaw Hospital between January 2011 and Apirl 2012. A total of sixty patients were analysed. Patients received pelvic radiation (44-50Gy/22-25F) and concomitant Capecitabine(825mg/m2/d, bid) combined with Oxaliplatin (85 mg/m2 weekl,3).Total mesorectal excision(TME) were underwent 6-12 weeks after the completion of chemoradition. And all pathological specimens were Specialized processed by pathologists of our hospital, the TNM stage were determined, then, the efficacy of preoperative chemoradiotherapy were evaluated by contrast the tumor size, TNM stage, sphincter preservation before and after neoadjuvant chemoradiotherapy. Then calculate the survival rates by the way of Kaplan-Meier after a long time follow-up. Analysing prognosis by COX Regression analysis.Follow-up:All of the 60 patients in group were followed up by the way of out-patient review, hospitalization and telephone except that two of them were lost. The end time was January 10,2016. The average follow-up time is 47.6 months and median follow-up time is 48.8 months.Results:1.The average tumor diameter before treatment was 6.1cm(measured by magnetic resonance imaging), and 2.2cm after radical surgery(measured on the specimen), an average reduction of 63.9% compared with preoperative tumor size. And the overall tumor response rate was 87.5%.2. According to TNM stage standard,18 of 60 patients down-staging at the rate of 30%. Among the 46 patients with Lymph node metastasis before operation,36 of them changed into node-negative.12 patients (20%) were evaluated as pathological complete response (pCR). The incidences of grade 3 hematologic toxicity were 6.7%(4/60).3.39 patients scheduled receiving abdominal perineal resection (Miles’), underwent the operation of anal sphincter preservation in 17 cases, sphincter preservation rate was 43.6%.4. After a 48.8 months median follow-up time, the four-year LR (local recurrence), distant metastasis, DFS (disease-free survival) and OS (overall survival) rates were 3.4%,22.4%,71.5% and 87.95%, respectively.5. The main hematologic toxicities were anemia,leukopenia and thrombocytopenia, 4 of them developed grade 3 hematologic toxicities. The non-hematological toxicological reactions are mainly diarrhea, nausea and radiodermatitis. None of them with grade 3 or higher non-hematologic toxicity.6. Multivariate analysis showed normal level of CA-199 (CA-199<37IU/ml) indicated a better prognosis. However, CEA, lymph node metastasis, and cancer nodules had no significant correlation with OS and DFS. Conclusion:Neoadjuvant chemoradiotherapy can shrank rectum tumors and degrade the staging.And some get pathologic complete response, but did not raise the sphincter preservation; Oxaliplatin using with three weeks of administration, combined with Capecitabine and radiotherapy was feasible, given the low toxicity and promising activity; Patients with normal level of CA-199 indicated a better prognosis. Further studies are needed to expand the samples. |
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