Clinical Study Of Short Course Radiotherapy Combined With Neoadjuvant Chemotherapy In The Treatment Of Locally Advanced Rectal Cancer And Prognosis Analysis Of Total Mesorectal Resection In The Treatment Of Rectal Cancer

PartⅠ Clinical study of short course radiotherapy combined with neoadjuvant chemotherapy in the treatment of locally advanced rectal cancerObjective:To explore the feasibility and safety of preoperative short course radiotherapy(SCRT)combined with neoadjuvant chemotherapy(NACT)in the treatment of locally advanced rectal cancer,and to explore whether SCRT combined with NACT can be a new model of neoadjuvant therapyMethods:1.This study is a retrospective analysis.Collected from January 1,2015 to December 31,2018 in Jilin Provincial Cancer Hospital as the "STELLAR" Phase Ⅲ non-inferiority randomized study of the Cancer Hospital of the Chinese Academy of Sciences sub-centers enrolled in the group Ⅱ,Forty-nine patients with stage Ⅲ rectal cancer were divided into study group and standard group according to the treatment methods of the enrolled patients.2.The studygroup is a short-course radiotherapy group(SCRT+NACT+TME+ADCT),that is,the radiotherapy tissue dose of rectal lesions and pelvic lymphatic drainage area:25Gy/5 times per week;1 week after radiotherapy,combined XELOX regimen neoadjuvant chemotherapy for 4 cycles;2-4 weeks after chemotherapy,complete mesorectal resection(hereinafter referred to as TME)surgery;combined with postoperative adjuvant XELOX chemotherapy for 2 cycles(see appendix for details).3.The standard group is the long-term concurrent radiotherapy and chemotherapy group(CRT),that is,the radiotherapy tissue dose of the rectal lesion and the pelvic lymphatic drainage area:50Gy/25 times/5 weeks,simultaneous oral capecitabine single-agent concurrent chemotherapy during radiotherapy;radiotherapy and chemotherapy are over TME surgery is performed after 6-8 weeks;postoperative adjuvant XELOX chemotherapy for 6 cycles(see appendix for details).4.Case collection,telephone follow-up,outpatient follow-up and other methods of 49 patients were followed up to collect information.Use Excel 2019 statistical data,use IBM SPSS Statistics 23.0 software to analyze all data,and use risk consistency,risk difference,and prognosis prediction to analyze the significance of the difference.P<0.05 indicates a significant difference.Compare the above two regimens in the incidence of adverse reactions,tumor downstage,R0 resection rate,3-year overall survival(OS),disease-free survival(DFS),and survival without distant metastasis during treatment.Rate(DMFS)and recurrence-free survival(RFS),local recurrence-free survival(LRFS),and regional recurrence-free survival(RRFS).Result:1.Adverse Reactions:During neoadjuvant therapy,the incidence of Ⅲ degree radiation dermatitis was 12%(3/25)in the standard group.The incidence of Ⅲ degree leukopenia was 8.3%(2/24),mild degree thrombocytopenia was 12.5%(2/24),and diarrhea was 8.3%(2/24).2.Preoperative neoadjuvant therapy showed good rates of T and N reduction and pathological complete response(PCR).In the study group,100%R0 resection was achieved,and YPT0N0 was achieved after neoadjuvant therapy,that is,PCR patients accounted for 13.0%.The T-and N-decreasing rates were 34.7%and 60.9%respectively.In the standard group,94.7%achieved R0 resection,15.8%achieved PCR after neoadjuvant therapy,68.4%of T and 63.25%of N reduction rates.The standard group showed better rates of T and N reduction and pathological complete response.But there was no statistical difference between the two.3.In the study group,OS,DFS,DMFS,RRFS and RFS were 87.0%,83.0%,91.0%,95.6%,respectively.In the standard group,the 3-year OS was 96.0%,DFS was 84.0%,DMFS was 88.0%,RFS was 88.0%,LRFS and RRFS were 96.0%.There was no statistically significant difference in survival between the two groups.Conclusion:1.The acute toxicity tolerance of the study group and the standard group can be.2.The preoperative neoadjuvant treatments all showed better T and N downgrade rates and pathological complete remission rates,and the study group had better treatment completion rates and R0 resection rates.3.The curative effect of preoperative short-term radiotherapy combined with surgery for locally advanced rectal cancer is not inferior to long-term concurrent radiotherapy and chemotherapy combined with surgery.PartⅡ Prognostic analysis of laparoscopic radical resection of rectal cancer for rectal cancerObjective:To investigate the therapeutic effect of laparoscopic radical resection of rectal cancer.(mainly survival:OS,DFS,LRFS,RRFs,DMFS),and then evaluate the related factors of prognosis of rectal cancer.Methods:1.Retrospective analysis of patients diagnosed with primary rectal cancer in Jilin Provincial Cancer Hospital from January 1,2013 to September 30,2018 and underwent laparoscopic radical resection of rectal cancer under general anesthesia.The follow-up period ended on September 12,2020.On the same day,excluding 34 patients who were lost to follow-up and patients who had undergone preoperative neoadjuvant treatment,a total of 274 patients were included.2.Use Excel 2019 statistics data,analyze all data using IBM SPSS Statistics 23.0 software,and analyze the importance of differences using risk consistency,risk differences,and prognosis prediction.The Kaplan-Meier method was used for survival statistics,the Cox risk ratio model was used for single factor and multivariate analysis,the relative hazard ratio(HR)was calculated,and the multivariate analysis was performed later.A P-value<0.05 is considered statistically significant..3.A total of 12 patients in stage Ⅳ were excluded in the COX survival analysis.That is,the survival analysis of the remaining 262 patients with non-IV stage surgery and the compilation of survival curves.4.According to statistics,119 patients with stage Ⅲ rectal cancer undergoing TME surgery were divided into two groups according to whether they received further adjuvant therapy(including postoperative adjuvant radiotherapy and chemotherapy),namely,no adjuvant therapy group and adjuvant therapy group.Among them,36.13%(43/119)received no adjuvant treatment,and 63.87%(76/119)received postoperative adjuvant treatment.Postoperative adjuvant treatment specifically includes adjuvant chemotherapy,adjuvant radiotherapy,adjuvant chemotherapy 100%(76/76),full cycle chemotherapy(chemotherapy over 4 cycles)67.1%(51/76),and inadequate chemotherapy 32.9%(25/76).Adjuvant radiotherapy was 22.4%(10/76),of which 58.9%(10/17)was adequate radiotherapy(radiotherapy tissue dose>50Gy),and 41.1%(7/17)was insufficient radiotherapy.In the adjuvant therapy group,7 patients achieved sufficient radiotherapy and chemotherapy,accounting for 9.2%of the adjuvant therapy group.In the adjuvant treatment group after surgery,there were 7 patients with adequate radiotherapy and chemotherapy.By the time of follow-up,there were no deaths,distant metastasis,local recurrence,and regional lymph node recurrence.Among patients who did not receive adjuvant therapy after surgery,9.3%(4/43)died,14.0%(6/43)distant metastases,9.3%(4/43)local recurrence,and 4.7%(2/43)regional lymph node recurrence.In the non-adjuvant therapy group,3-year OS 87.0%,3-year DFS 83.0%,3-year DMFS 83.0%,3-year RFS 87.0%,3-year LRFS 87.0%,3-year RRFS 89.0%,all of which were lower than adequate postoperative dose Patients in the adjuvant treatment group.Results:①Median OS:41.25(0.83-90.73)months,median DFS:40.27(0.00-90.73)months;median DMFS:40.27(0.0-90.73)months;median RFS:40.54(0.03-90.73)Months;median LRFS:40.78(0.03-90.73)months,median RRFS:40.78(0.03-90.73)months.②The patients with stage Ⅱ and Ⅲ were 37.2%(102/274)and 43.4%(119/274)respectively,which accounted for the highest proportion.Stage I patients have the best survival data,and stage Ⅳ patients have the worst survival data.③Positive circumcisional margins(hereinafter referred to as CRM),number of lymph nodes submitted for examination ≤11,and mucinous pathological type suggesting a poor prognosis for OS,which is statistically significant for OS.Positive CRM and nerve invasion suggest a poor prognosis for DFS,which is statistically significant for DFS.Positive CRM,nerve invasion,and the number of lymph nodes submitted for examination ≤11 indicate a poor prognosis for DMFS,which is statistically significant for DMFS.The pathological type is mucinous,and the positive CRM indicates that the prognosis of RFS and LRFS is poor,and there is statistics for RFS and LRFS.Positive CRM is an independent prognostic factor for RRFS.④In the subgroup analysis of pathological types,the number of mucinous cases was relatively small,but the statistical results were fair.In the subgroup analysis of pathological types,the protuberance type)ulcer type)mucoid type was statistically significant;in the subgroup analysis of the circumcision margin,the circumcision margin was negative)the circumcision margin was negative)cannot be assessed,and there was statistical significance;lymph nodes were submitted for examination The number ≤11 indicates a poor prognosis,which is statistically significant;Nerve non-invasion)Nerve-invasion,but not statistically significant.⑤The prognosis of patients with positive lymph nodes is poor.The more positive lymph nodes,the worse the prognosis.Conclusion:1.Rectal cancer in my country is characterized by a high proportion of locally advanced cancer.Early detection and early intervention have a better impact on long-term survival.2.Postoperative adjuvant treatment is meaningful for the survival of patients with locally advanced rectal cancer,and individualized comprehensive treatment should be given to patients with locally advanced rectal cancer.3.Positive circumcision margin is a risk factor for local recurrence and distant metastasis of rectal cancer.Positive circumcisional margin is an independent factor for regional lymph node recurrence.4.Lymph node positivity is an independent factor for the prognosis and survival of rectal cancer.The prognosis of rectal cancer with positive lymph nodes is poor.