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目的探讨中低位进展期直肠癌患者术前行三维适形放疗(3DCRT)联合卡培他滨化疗与单纯行XELOX化疗的临床疗效。方法将该院2010年1月至2012年12月入选的70例进展期直肠癌患者随机分为同步放化疗组(38例)与单纯化疗组(32例),前者予3DCRT同步卡培他滨化疗,后者予卡倍他滨+奥沙利铂化疗方案,均治疗2个周期,对比治疗结束后疗效、毒副反应、癌胚抗原(CEA)水平及手术保肛率。结果同步放化疗组肿瘤控制率(92.1%)高于单纯化疗组(81.3%)(P>0.05)。两组治疗期间不良反应类型及发生率相近;此外,同步放化疗组出现特异性放疗损伤6例(15.8%),单纯化疗组出现2例置管处感染(6.3%)。同步放化疗组CEA水平(12.1±4.4)ng/ml明显低于单纯化疗组(14.4±4.8)ng/ml(P<0.05),术后两组CEA水平均阴转。同步放化疗组、单纯化疗组手术保肛率分别为82.9%、66.7%,差异不具有统计学意义(χ2=2.282,P=0.131)。结论 3DCRT同步卡培他滨化疗与XELOX化疗均是术前辅助治疗进展期中低位直肠癌的有效方案,前者在控制肿瘤进展、提高手术保肛率方面更具有优势。
Objective To investigate the clinical effects of three-dimensional conformal radiotherapy (3DCRT) combined with capecitabine and simple XELOX chemotherapy in patients with advanced low rectal cancer. Methods 70 patients with advanced rectal cancer selected from January 2010 to December 2012 in our hospital were randomly divided into concurrent chemoradiotherapy group (38 patients) and chemotherapy alone group (32 patients). The former received 3DCRT synchronous capecitabine Chemotherapy, the latter to card Betanabine + oxaliplatin chemotherapy, were treated 2 cycles, the efficacy of treatment after the end of the comparison, toxicity, carcinoembryonic antigen (CEA) level and the rate of operation anal sphincter. Results The rate of tumor control (92.1%) in concurrent chemoradiotherapy group was higher than that in chemotherapy group (81.3%) (P> 0.05). There were 6 cases (15.8%) of radiotherapy-specific radiotherapy injury in concurrent chemoradiation group and 2 cases of catheterization (6.3%) in chemotherapy alone group. The CEA level in the concurrent chemoradiotherapy group (12.1 ± 4.4) ng / ml was significantly lower than that in the chemotherapy alone group (14.4 ± 4.8) ng / ml (P <0.05). The rate of anal sphincter preservation in the concurrent chemoradiotherapy group and chemotherapy alone group was 82.9% and 66.7% respectively, with no significant difference (χ2 = 2.282, P = 0.131). Conclusions 3DCRT simultaneous capecitabine chemotherapy and XELOX chemotherapy are all effective preoperative adjuvant therapy for advanced low rectal cancer. The former has more advantages in controlling tumor progression and improving the rate of operative anal sphincter preservation.