Analysis Of The Efficacy Of Total Neoadjuvant Therapy For Middle And Low Rectal Cancer

Objective: To explore the therapeutic effect and safety of the tatal neoadjuvant therapy in patients with middle and low rectal cancer,and to provide clinical data for the treatment mode of the total neoadjuvant therapy for middle and low rectal cancer.Methods: A retrospective analysis of the data of 310 rectal cancer patients treated with radiotherapy and chemotherapy in Dalian Medical University Anorectal Surgery from January 2015 to January 2021,of which 78 patients are included in this study,XELOX chemotherapy(2 cycles)+simultaneous radiotherapy and chemotherapy + XELOX chemotherapy(2-4 cycles)/ oral capecitabine(2 cycles)of the total neoadjuvant treatment plan,the total neoadjuvant treatment 6-8 weeks after the main reference to the Memorial Sloan Kettering Cancer Center(Memorial Sloan Kettering)Cancer Center,MSKCC)evaluate the patients,clarify the different curative effects.choose different treatment strategies,and follow up regularly to analyze the complications and survival of patients after different treatments.Results:The entire group of patients is 50 males(64.10%)and 28 females(35.90%).The median age is 62 years(29-82 years).The distance between the lower edge of the tumor and the anal edge is 3cm(0-10cm).XELOX chemotherapy regimen(Oxaliplatin 130mg/m~2,intravenous infusion on day 1.Capecitabine 1000mg/m~2 orally twice a day,from day 1 to day 14,repeat every 3 weeks for 12 weeks)+ concurrent chemotherapy(5 weeks)58 patients(74.36%),XELOX chemotherapy regimen(2 cycles)+ long-term radiotherapy 50Gy/25 times,single dose 2.0Gy,5 weeks in total),oral Xeloda(ie capecitabine 825mg)/m~2,Bid,5 days a week)+ continued oral Xeloda(2 cycles)chemotherapy regimen in 20 patients(25.64%).The curative effect after the total neoadjuvant treatment is based on the response evaluation criteria in solid tumors(RECIST)of the National Cancer Institute in 2000.After total neoadjuvant treatment,17 cases of clinical complete remission(cCR)(21.79%)Among them,4 cases of pathological complete remission(p CR)(5.13%),45 cases of clinical partial remission(PR)(57.69%),15 cases of stable disease(SD)(19.23%),and 1 case of disease progression(PD)(1.28%)),the overall effective rate is 79.48%.The overall tumor shrinkage rate after the operation is 62.54%,and the distant metastasis rate is 6.41%(5/78),including 3 cases of lung metastasis,1 case of liver metastasis to lung and 1 case of brain metastasis.There are no cases of local regeneration.The patients in this group are followed up for a median of 30.5(3-70)months,and they are followed up until January 2021.In this group,the 3-year OPR is 82.35%(14/17),the 3-year SPR is 64.10%(50/78),the 3-year DFS is 76.92%,and the 3-year OS is 100%.Conclusion: The total neoadjuvant treatment of advanced middle and low rectal cancer is safe and reliable.The total downstage rate of this group of cases is 79.48%,and 17 cases of clinical cCR(21.79%)have mild side effects and no increase in perioperative complications.Survival treatment,3 years DFS 76.92%,is a safe and effective treatment for patients with middle and low rectal cancer.