Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
ObjectiveTo analyze the clinical predictive factors of tumor pathological response to preoperative chemoradiotherapy for rectal cancer. MethodsOne hundred and seven patients treated with preoperative capecitabine and pelvic conformal radiotherapy and underwent total mesorectal excision from January 2005 to December 2012 in this hospital were analyzed retrospectively.Tumor response according to tumor regression grade was evaluated.The correlation of clinicopathologic factors with tumor response was analyzed by logistic regression analysis. ResultsThe single factor analysis results showed that the age, gender, distance of tumor from anal verge, differentiation degree of tumor, infiltration depth of tumor, and pretreatment CA19-9 level were not correlated with rectal cancer pathological response to preoperative chemoradiotherapy (P > 0.05).The tumor circumferential extent, tumor mobilit, lymph node metastasis, pretreatment carcinoembryonic antigen (CEA) level, and pretreatment hemoglobin level were correlated with it (P < 0.05).The logistic regression analysis results showed that non-fixed tumor (P=0.015), pretreatment CEA level≤5.0μg/L (P=0.012), and pretreatment hemoglobin level > 10 g/L (P=0.007) independently predicted a good pathologic response rate. ConclusionTumor mobility, pretreatment CEA level, and hemoglobin level are important predictors of pathological response to preoperative chemoradiotherapy in rectal cancer.
Objective To evaluate the efficacy and safety of neoadjuvant chemotherapy (a CRTS group) plus surgery versus surgery alone (a SA group) in the treatment of resectable esophageal neoplasms. Methods PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results Twenty-six RCTs included 3 252 patients (1 606 in the CRTS group, 1 646 in the SA group) were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk (RR) value and 95%CI at 1.24 (1.13–1.36, P<0.000 1), 1.29 (1.10–1.50,P=0.001), 1.13 (1.05–1.212, P=0.001), 0.67 (0.52–0.85, P=0.001), 0.60 (0.40–0.90, P=0.013). And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR (95%CI) of 1.05 (0.99–1.12, P=0.103) and 0.84 (0.70–1.00, P=0.053). There was no significant difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR (95%CI) at 1.09 (0.96–1.24, P=0.166), 1.32 (0.96–1.83, P=0.485), 1.45 (0.94–2.23, P=0.091), 0.89 (0.63–1.25, P=0.485), 0.93 (0.64–1.35, P=0.731), 1.24(0.84–1.87, P=0.283), and 1.62 (0.85–3.07, P=0.142). Conclusion CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.