Elwanis Mostafa Abd, Maximous Doaa W, Elsayed Mohamed Ibrahim, Mikhail Nabiel N H
Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut, Egypt.
World J Surg Oncol. 2009 Jun 9;7:52. doi: 10.1186/1477-7819-7-52.
Treatment of rectal cancer requires a multidisciplinary approach with standardized surgical, pathological and radiotherapeutic procedures. Sphincter preserving surgery for cancer of the lower rectum needs a long-course of neoadjuvant treatments to reduce tumor volume, to induce down-staging that increases circumferential resection margin, and to facilitate surgery.
To evaluate the rate of anal sphincter preservation in low lying, resectable, locally advanced rectal cancer and the resectability rate in unresectable cases after neoadjuvent chemoradiation by oral Capecitabine.
This trial included 43 patients with low lying (4-7 cm from anal verge) locally advanced rectal cancer, of which 33 were resectable. All patients received preoperative concurrent chemoradiation (45 Gy/25 fractions over 5 weeks with oral capecitabine 825 mg/m2 twice daily on radiotherapy days), followed after 4-6 weeks by total mesorectal excision technique.
Preoperative chemoradiation resulted in a complete pathologic response in 4 patients (9.3%; 95% CI 3-23.1) and an overall downstaging in 32 patients (74.4%; 95% CI 58.5-85). Sphincter sparing surgical procedures were done in 20 out of 43 patients (46.5%; 95% CI 31.5-62.2). The majority (75%) were of clinical T3 disease. Toxicity was moderate and required no treatment interruption. Grade II anemia occurred in 4 patients (9.3%, 95% CI 3-23.1), leucopenia in 2 patients (4.7%, 95% CI 0.8-17) and radiation dermatitis in 4 patients (9.3%, 95% CI 3-23.1) respectively.
In patients with low lying, locally advanced rectal cancer, preoperative chemoradiation using oral capecitabine 825 mg/m2, twice a day on radiotherapy days, was tolerable and effective in downstaging and resulted in 46.5% anal sphincter preservation rate.
直肠癌的治疗需要多学科方法，包括标准化的手术、病理和放射治疗程序。低位直肠癌的保肛手术需要长期的新辅助治疗，以缩小肿瘤体积、诱导降期从而增加环周切缘，并便于手术操作。
评估口服卡培他滨进行新辅助放化疗后，低位、可切除、局部晚期直肠癌的肛门括约肌保留率以及不可切除病例的可切除率。
本试验纳入了43例低位（距肛缘4 - 7厘米）局部晚期直肠癌患者，其中33例可切除。所有患者均接受术前同步放化疗（5周内分25次给予45 Gy，放疗期间每日两次口服卡培他滨825 mg/m²），4 - 6周后行全直肠系膜切除技术。
术前放化疗使4例患者（9.3%；95%可信区间3 - 23.1）达到完全病理缓解，32例患者（74.4%；95%可信区间58.5 - 85）总体降期。43例患者中有20例（46.5%；95%可信区间31.5 - 62.2）进行了保肛手术。大多数（75%）为临床T3期疾病。毒性反应为中度，无需中断治疗。分别有4例患者（9.3%，95%可信区间3 - 23.1）发生II级贫血，2例患者（4.7%，95%可信区间0.8 - 17）发生白细胞减少，4例患者（9.3%，95%可信区间3 - 23.1）发生放射性皮炎。
对于低位局部晚期直肠癌患者，放疗期间每日两次口服825 mg/m²卡培他滨的术前放化疗耐受性良好，降期效果有效，肛门括约肌保留率达46.5%。
