目的:對低位或局部侵犯厲害直腸癌的病人以于術前放射合併化學治療的方式，評估其肛門括約肌保存率及降低疾病分期之治療成果。

材料與方法:從1999年到2001年，共有15位直腸癌的病人(13位男性、2位女性)在本院接受于術前放射合併化學治療的方式。其中三位患有局部侵犯厲害直腸癌，另外12位則患有腫瘤距離肛門括約肌6公分以內的低位直腸癌。病人年紀分佈範圍自27到73歲不等。依據治療前電腦斷層檢查及肛門觸診作為臨床分期的標準，則計有2位AJCC分期T2NO、10位T3NO、1位T3Nl、2位T4NO的病人。這些病人均接受每日分次劑量1.8 Gy ，骨盆腔總劑量的Gy的傳統多照野放射線治療，同時台併以5-FU為主的化學治療，並在放射治療及化學治療完成後6到8週接受手術。

結果:有10位病人(679毛)經手術後病理報告證實腫瘤疾病分期確有降低，其中包括3位腫瘤 完全消失、l位TINO、4位T2NO'和2位T3NO的病人。在12位低位宜腸癌的病人中有8位(67%)可以達到肛門括約肌保存的目的。15位病人的術式分別為:直腸切除及大腸肛門吻合術(7位)、低前位切除術(4位)、經腹部會陰切除術(4位)。治療過程中並沒有發生嚴重治療副作用的情形;同時，到目前為止存活的病人中均沒有疾病局部復發。

結論:手術前放射合併化學治療的方式對低位或局部侵犯厲害直腸癌的病人有67%可以得到降低腫瘤分期的效果，在低位直腸癌的病人有67%亦可以達到肛門括約肌保存的目的，同時病人有很好的耐受性，臨床上是一個可行的方式。

Purpose:To evaluate the rates of tumor down-staging and sphincter-sparing surgery for low or locally advanced rectal cancers after preoperative radiotherapy and chemotherapy. Methods and Materials : During the period between 1999 and 2001， 15 patie川s (13 males and 2 females) received preoperative radiotherapy and chemotherapy followed by surgery for localized adenocarcinoma of the rectum. Three of them had locally advanced unresectable rectal cancer and 12 patients had low-lying rectal cancer (within 6 cm from the anal verge). Patien峙， age ranged from 27 to 73 years (median， 48). Pretreatment tumor stages， determined by the CT scan， included 2 with T2NO， 10 with T3NO， 1 with T3N1， and 2 with T4NO. The preoperative treatment procedure consisted of conventionally fractionated irradiation of 45 Gy in 25 fractions to the pelvis with concomitant 5FUbased chemotherapy 6-8 weeks before surgery.

Methods and Materials:Tumor down-staging was pathologically confirmed in 10 (67%) of 15 patients， including 3 with complete response (CR)， 1 T1 NO， 4 T2NO， and 2 T3NO disease. Sphincter preservation was accomplished in 8 (67%) of 12 low rectal cancer patients. The surgical procedures included proctectomy and coloanal anastomosis (n = 7)， low anterior resection (n = 4)， and abdominoperineal resection (n = 4). All patients tolerated the c心mbined chemoradiotherapy approach well without grade 3 or 4 toxicity. There was no pelvic disease recurrence till now

Conclusion : The combination of preoperative pelvic radiation and 5-FU infusional chemotherapy in the management of low or locally advanced rectal cancers was well tolerated. Preoperative chemoradiotherapy resulted in significant tumor down-staging， allowing sphincter-sparing surgery in 67% of patients whose tumors were located within 6 cm from the anal verge and who otherwise would have required a colostomy.