Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
J Surg Oncol. 2010 Dec 1;102(7):771-7. doi: 10.1002/jso.21711.
Preoperative chemoradiotherapy (CCRT) followed by radical resection is an option for advanced low rectal cancer. This study was aimed to clarify the impact of CCRT on patients' outcome.
One hundred thirty-six patients with rectal cancer (<10 cm from anal verge) were enrolled prospectively between July 2000 and December 2004. The preoperative clinical stage was T3, T4, or node-positive disease. Sixty-nine and 67 patients underwent surgery with and without preoperative CCRT, respectively. The regimen of pre-op CCRT was a radiation dosage of 45 Gy in 20 fractions and oral tegafur-uracil (UFUR) and leucovorin.
There was no statistical difference in the preserved anorectal function between two groups after 5 years of follow-up (62.3% vs. 47.8%; P = 0.125). The 5-year overall survival and disease-free survival (DFS) percentage were 88.4% and 76.8% for patients with preoperative CCRT, and 65.7% and 58.2% for patients without CCRT, respectively. Patients with preoperative CCRT had a higher overall survival rate and DFS (P = 0.001 and 0.015).
In patients with advanced low rectal cancer, preoperative CCRT followed by radical surgery significantly improved overall survival and DFS compared with surgery alone. The effect of sphincter preservation with preoperative CCRT is questionable.
术前放化疗（CCRT）后行根治性切除术是治疗中低位进展期直肠癌的一种选择。本研究旨在明确 CCRT 对患者预后的影响。
2000 年 7 月至 2004 年 12 月，前瞻性纳入 136 例距肛缘<10cm 的直肠癌患者。术前临床分期为 T3、T4 或淋巴结阳性。69 例和 67 例患者分别接受了术前 CCRT 联合和不联合手术治疗。术前 CCRT 方案为 45Gy/20 次放疗联合口服替加氟-尿嘧啶（UFUR）和亚叶酸钙。
5 年随访后，两组患者保肛功能无统计学差异（62.3% vs. 47.8%；P=0.125）。术前 CCRT 组患者的 5 年总生存率和无病生存率（DFS）分别为 88.4%和 76.8%，而未行 CCRT 组分别为 65.7%和 58.2%。术前 CCRT 组患者的总生存率和 DFS 更高（P=0.001 和 0.015）。
对于中低位进展期直肠癌患者，术前 CCRT 联合根治性手术可显著提高总生存率和 DFS，优于单纯手术治疗。术前 CCRT 对保肛效果的影响尚存在争议。
