RESUMO
Objective: To evaluate the efficacy and safety of neoadjuvant concurrent chemoradiotherapy combined with TME (total mesorectal excision) for the treatment of locally advanced middle and lower rectal cancer. Methods: Thirty patients with locally advanced middle and lower rectal cancer were recruited between September 2009 and February 2011, 14 of whom had stage II (T 3-4N0M0) and 16 had stage III (T1-4 N1-2M0). All patients received neoadjuvant concurrent chemoradiotherapy [the total dose of preoperative radiotherapy was 45-50 Gy (1.8 Gy/fx), concurrently combined with two cycles of FOLFOX4 regimen]. The surgical operation was performed 4-6 weeks after concurrent chemoradiotherapy, following the principle of TME. Results: All patients completed the neoadjuvant concurrent chemoradiotherapy. Of these thirty patients, 5 received complete response, 18 received partial response, 7 received stable disease, and 23 patients obtained downstaging (76.6%). Except one patient who receiving complete response rejected the surgical operation, 23 patients received low/ultra-low anterior resection (Dixon), and 6 patients received abdominoperineal resection (Miles) 4-6 weeks after chemoradiotherapy. The sphincter preservation rate was 80.0% (24/30). No perioperative death was observed, and the overall incidence of complication was 20.7% (6/29). Conclusion: Neoadjuvant concurrent chemoradiotherapy combined with TME for treatment of locally advanced middle and lower rectal cancer is effective and safe, which can reduce the tumor stage and increase the complete tumor resection and sphincter preservation rates, and can also improve the quality of life. Copyright© 2011 by TUMOR.