Fundamental research on the extraction of a high-risk group in rectal cancer, and the adjuvant treatment of the surgically treated rectal cancer.

为了改善直肠癌患者的预后，我们继续努力预防盆腔和远处复发，并对复发病例进行治疗。为防止局部复发，我院采用放化疗联合手术的新辅助治疗已达15年。局部和全身化疗用于治疗更广泛的疾病。我们对这些治疗方法的临床效果进行评价，并从根本上和临床上探讨更多的改善点。并获得了以下知识。1.70例中、低位直肠癌患者行术前放疗，放疗剂量为20Gy / 4次/周。化疗命名为PMC （pharmacokinetic modulating chemotherapy，药代动力学调节化疗），采用UFT联合5FU连续输注的化疗方法，每周术前随机抽取35例（单独放疗组与新化疗辅助组）。阳性淋巴结转移率从40%下降到23%，新化疗辅助组的分期下降。直到这一时期才发现盆腔复发。2. 结直肠癌肝转移灶切除术后，采用肝动脉输注的局部PMC可显著降低肺转移的发生率。PMC组肝切除术后累积5年生存率（59%）显著高于对照组（27%）。3. 从根本上证明了PMC的作用机制。研究表明，PMC对以氟尿嘧啶为基础的化疗靶点的细胞周期的影响也在G2-/M检查点，而在G1-/G0检查点受到影响。采用新辅助治疗，91%的直肠癌患者行保括约肌手术，至今未发现盆腔复发病例。总之，我们的治疗方式可以改善直肠癌患者的预后，提高患者的生活质量。少

For the purpose to improve the prognosis of rectal cancer patients, we have continued efforts to prevent both pelvic and distant recurrence, and to treat the recurrent cases. To prevent local recurrence, the neo-adjuvant treatment combined radiation and chemotherapy with surgery has been used in our institute for 15 years. And the regional and systemic chemotherapy was performed to treat more extended disease. We evaluated the clinical results of these treatments, and investigated the more improving points fundamentally and clinically. and the following knowledge was acquired. 1.70 patients with middle or lower rectal cancer was undergone preoperative radiotherapy which was delivered 20Gy / 4 times / one week. The chemotherapy, named PMC (pharmacokinetic modulating chemotherapy) which uses UFT together to 5FU continuous infusion was performed preoperatively every week before an operation to randomized 35 cases of them (radiation-alone group vs. neo-chemoadjuvant group). The rate of a p … More ositive lymph node metastases decreased from 40% to 23%, and down-staging was found in the neo-chemoadjuvant group. The pelvic recurrence was not found till in this period. 2. The regional PMC using hepatic arterial infusion after resection of colorectal liver metastases enabled to decrease the prevalence of lung metastasis significantly. Cumulative 5-year survival rate after hepatectomy in PMC group (59%) was significantly higher in control group (27%). 3. Fundamentally, we proved the mechanism which PMC takes effect. It was shown that PMC effects on the cell cycle also at a G2-/M checkpoint in a target of the fluorouracil based chemotherapy which has been effected at G1-/G0 checkpoint. By using the neo-adjuvant treatment, the sphincter preservationoperation has been performed to 91% of a rectal cancer case, and the pelvic recurrence case is not found till present. In conclusion, our treatment modalities could improve the prognosis of rectal cancer patients with higher quality of life. Less