Neoadjuvant Chemoradiotherapy Combined with SphincterPreserving Surgery in Treatment of 34 Patients with Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XUE Xiaojun , CHEN Shaoquan , TU Xiaohuang , SONG Jingxiang.

Department of General Surgery, Fuzhou General Hospital of Nanjing Military Command, Fuzong Medical College, Fujian Medical University, Fuzhou 350025, China;

Corresponding author：

Keywords：

Neoadjuvant chemoradiotherapy; Low rectal cancer; Sphincter-preserving surgery; Sensitivity

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Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer.
Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy.
Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter.
Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.

Citation： XUE Xiaojun,CHEN Shaoquan,TU Xiaohuang,SONG Jingxiang.. Neoadjuvant Chemoradiotherapy Combined with SphincterPreserving Surgery in Treatment of 34 Patients with Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 824-827. doi: Copy

1.	涂小煌, 张再重, 陈少全, 等. 全直肠系膜切除术安全远切端距离的临床研究 [J]. 中国普通外科杂志， 2009； 18（11）: 11751179.
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4.	刘征云, 田福年. 应用TME技术治疗中低位直肠癌的体会[J]. 中国普外基础与临床杂志, 2008； 15（11）: 844845.
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6.	Ulrich A, Weitz J, Slodczyk M, et al. Neoadjuvant treatment does not influence perioperative outcome in rectal cancer surgery[J]. Int J Radiat Oncol Biol Phys, 2009； 75（1）: 129136.
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9.	唐宗江, 郭云, 唐卫中. 术前放化疗对低位直肠癌患者细胞免疫功能及保肛的影响 [J]. 结直肠肛门外科, 2007； 13（3）: 150152.
10.	郁宝铭, 吴唯勤. 新辅助化放疗与TME联合治疗局部进展期低位直肠癌 [J]. 中国实用外科杂志, 2005； 25（5）: 270272.
11.	Beddy D, Hyland JM, Winter DC, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy [J]. Ann Surg Oncol, 2008； 15（12）: 34713477.
12.	Caricato M, Ausania F, De Dominicis E, et al. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer[J]. Eur J Surg Oncol, 2007； 33（6）: 724728.
13.	曾智帆, 丁培荣, 潘志忠, 等. 直肠癌新辅助治疗后淋巴结转移相关因素分析 [J]. 癌症, 2009； 28（9）: 923927.
14.	Ciccocioppo A, Stephens JH, Hewett PJ, et al. Complete pathologic response after preoperative rectal cancer chemoradiotherapy[J]. ANZ J Surg, 2009； 79(6): 481484.
15.	Castaldo ET, Parikh AA, Pinson CW, et al. Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer[J]. Arch Surg, 2009； 144(2): 129135.
16.	郁宝铭, 张敏, 吴唯勤. 肿瘤降期在低位直肠癌新辅助治疗中的意义 [J]. 世界华人消化杂志, 2007； 15（32）: 34463450.
17.	Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum: NSABP R03[J]. J Clin Oncol, 2009； 27（31）: 51245130.
18.	Dhadda AS, Zaitoun AM, Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine—optimising the timing of surgical resection[J]. Clin Oncol (R Coll Radiol), 2009； 21（1）: 2331.
19.	HabrGama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period[J]. Dis Colon Rectum, 2009； 52(12): 19271934.
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21.	Kim NK, Kim YW, Min BS, et al. Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer [J]. World J Surg, 2009； 33（8）: 17411749.
22.	顾晋, 詹天成, 姚云峰. 结直肠癌的新辅助化疗 [J]. 中国普外基础与临床杂志, 2007； 14(6): 628629.
23.	HoPunCheung A, Assenat E, Thezenas S, et al. Cyclin D1 gene G870A polymorphism predicts response to neoadjuvant radiotherapy and prognosis in rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 68(4): 10941101.
24.	Lin LC, Lee HH, Hwang WS, et al. p53 and p27 as predictors of clinical outcome for rectalcancer patients receiving neoadjuvant therapy[J]. Surg Oncol, 2006； 15(4): 211216.
25.	Yasuda H, Tanaka K, Saigusa S, et al. Elevated CD133, but not VEGF or EGFR, as a predictive marker of distant recurrence after preoperative chemoradiotherapy in rectal cancer[J]. Oncol Rep, 2009； 22（4）: 709717.
26.	Perez RO, So Julio GP, HabrGama A, et al. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemoradiotherapy for distal rectal cancer[J]. Dis Colon Rectum, 2009； 52（6）: 11371143.
27.	Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy[J]. Int J Colorectal Dis, 2009； 24（7）: 741748.
28.	Baik SH, Kim NK, Lee KY, et al. Analysis of anal sphincter preservation rate according to tumor level and neoadjuvant chemoradiotherapy inrectal cancer patients[J]. J Gastrointest Surg, 2008； 12(1): 176182.
29.	Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response follow preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome[J]. Dis Colon Rectum, 2004； 47(11): 17981807.

1. 涂小煌, 张再重, 陈少全, 等. 全直肠系膜切除术安全远切端距离的临床研究 [J]. 中国普通外科杂志， 2009； 18（11）: 11751179.
2. 涂小煌, 张再重, 宋京翔, 等. 大口径肛管预防直肠癌术后吻合口漏的对比研究 [J]. 中国普外基础与临床杂志, 2009； 16（10）: 830833.
3. 范恩学, 房学东, 孙海侠, 等. 直肠癌TME与非TME手术的临床分析 [J]. 中国现代普通外科进展, 2009； 12（10）: 875878.
4. 刘征云, 田福年. 应用TME技术治疗中低位直肠癌的体会[J]. 中国普外基础与临床杂志, 2008； 15（11）: 844845.
5. den Dulk M, Collette L, van de Velde CJ, et al. Quality of surgery in T34 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Restult from EORTC trial 22921[J]. Eur J Cancer, 2007； 43（12）: 18211828.
6. Ulrich A, Weitz J, Slodczyk M, et al. Neoadjuvant treatment does not influence perioperative outcome in rectal cancer surgery[J]. Int J Radiat Oncol Biol Phys, 2009； 75（1）: 129136.
7. 章卫根, 章俊杰, 黄军平. 中低位直肠癌新辅助治疗的远期疗效 [J]. 实用医学杂志, 2009; 25（11）: 18061807.
8. Twu CM, Wang HM, Chen JB, et al. Neoadjuvant concurrent chemoradiotherapy in treating locally advanced rectal cancer[J]. J Chin Med Assoc, 2009； 72（4）: 179182.
9. 唐宗江, 郭云, 唐卫中. 术前放化疗对低位直肠癌患者细胞免疫功能及保肛的影响 [J]. 结直肠肛门外科, 2007； 13（3）: 150152.
10. 郁宝铭, 吴唯勤. 新辅助化放疗与TME联合治疗局部进展期低位直肠癌 [J]. 中国实用外科杂志, 2005； 25（5）: 270272.
11. Beddy D, Hyland JM, Winter DC, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy [J]. Ann Surg Oncol, 2008； 15（12）: 34713477.
12. Caricato M, Ausania F, De Dominicis E, et al. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer[J]. Eur J Surg Oncol, 2007； 33（6）: 724728.
13. 曾智帆, 丁培荣, 潘志忠, 等. 直肠癌新辅助治疗后淋巴结转移相关因素分析 [J]. 癌症, 2009； 28（9）: 923927.
14. Ciccocioppo A, Stephens JH, Hewett PJ, et al. Complete pathologic response after preoperative rectal cancer chemoradiotherapy[J]. ANZ J Surg, 2009； 79(6): 481484.
15. Castaldo ET, Parikh AA, Pinson CW, et al. Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer[J]. Arch Surg, 2009； 144(2): 129135.
16. 郁宝铭, 张敏, 吴唯勤. 肿瘤降期在低位直肠癌新辅助治疗中的意义 [J]. 世界华人消化杂志, 2007； 15（32）: 34463450.
17. Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum: NSABP R03[J]. J Clin Oncol, 2009； 27（31）: 51245130.
18. Dhadda AS, Zaitoun AM, Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine—optimising the timing of surgical resection[J]. Clin Oncol (R Coll Radiol), 2009； 21（1）: 2331.
19. HabrGama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period[J]. Dis Colon Rectum, 2009； 52(12): 19271934.
20. Sato T, Kokuba Y, Koizumi W, et al. Phase Ⅰ trial of neoadjuvant preoperative chemotherapy with S1 and irinotecan plus radiation in patients with locally advanced rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 69(5): 14421447.
21. Kim NK, Kim YW, Min BS, et al. Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer [J]. World J Surg, 2009； 33（8）: 17411749.
22. 顾晋, 詹天成, 姚云峰. 结直肠癌的新辅助化疗 [J]. 中国普外基础与临床杂志, 2007； 14(6): 628629.
23. HoPunCheung A, Assenat E, Thezenas S, et al. Cyclin D1 gene G870A polymorphism predicts response to neoadjuvant radiotherapy and prognosis in rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 68(4): 10941101.
24. Lin LC, Lee HH, Hwang WS, et al. p53 and p27 as predictors of clinical outcome for rectalcancer patients receiving neoadjuvant therapy[J]. Surg Oncol, 2006； 15(4): 211216.
25. Yasuda H, Tanaka K, Saigusa S, et al. Elevated CD133, but not VEGF or EGFR, as a predictive marker of distant recurrence after preoperative chemoradiotherapy in rectal cancer[J]. Oncol Rep, 2009； 22（4）: 709717.
26. Perez RO, So Julio GP, HabrGama A, et al. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemoradiotherapy for distal rectal cancer[J]. Dis Colon Rectum, 2009； 52（6）: 11371143.
27. Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy[J]. Int J Colorectal Dis, 2009； 24（7）: 741748.
28. Baik SH, Kim NK, Lee KY, et al. Analysis of anal sphincter preservation rate according to tumor level and neoadjuvant chemoradiotherapy inrectal cancer patients[J]. J Gastrointest Surg, 2008； 12(1): 176182.
29. Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response follow preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome[J]. Dis Colon Rectum, 2004； 47(11): 17981807.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Neoadjuvant Chemoradiotherapy Combined with SphincterPreserving Surgery in Treatment of 34 Patients with Rectal Cancer

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