Therapeutic efficacy of Jisheng Wumei Decoction retention enema combined with nCRT in the treatment of locally advanced rectal cancer

Dong Chaoqun; Shen Peng; Wang Yuhao; Ou Junming; Peng Yuchong; Wang Xiaoli; Wang Hongbo

doi:10.11986/j.issn.1673-873X.2024.07.08

Abstract：Objective To explore the efficacy of Jisheng Wumei Decoction retention enema combined with neoadjuvant che-moradiotherapy(nCRT)in the treatment of locally advanced rectal cancer and its effect on the prevention and treatment of radiation proctitis,in order to provide a reference for clinical treatment.Methods A total of 47 patients with rectal cancer treated in the Department of General Surgery,Chongqing Traditional Chinese Medicine Hospital from January 2020 to De-cember 2023 were selected as the study participants and randomly assigned to an observation group(n=24)and a control group(n=23)using the random number table method.The treatment plan for the observation group included capecitabine plus oxaliplatin chemotherapy combined with radiotherapy(CapeOX-CRT)and Jisheng Wumei Decoction retention enema.The control group's treatment plan included CapeOX-CRT plus placebo retention enema.The levels of serum tumor necrosis factor α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),malondialdehyde(MDA),and superoxide dismutase(SOD)before and after radiotherapy in both groups of patients were compared.The pathological response of the lesions after neoad-juvant therapy was compared,including cTNM,ypTNM staging,and the American National Comprehensive Cancer Net-work(NCCN)tumor regression grading(TRG).The occurrence of acute radiation proctitis of different grades after concur-rent chemoradiotherapy was compared between the two groups.Results Before radiation therapy,there was no statistically significant difference in the levels of IL-6,IL-8,TNF-α,and SOD between the two groups(P＞0.05).After radio therapy,the levels of IL-6,IL-8,and TNF-α in both groups were higher than before radiotherapy,but the observation group was sig-nificantly lower than the control group(P＜0.05).After radio therapy,the level of SOD of the observation group was high-er than the control group,with statistically significant differences(P＜0.05).The incidence of radiation proctitis and severe radiation proctitis in the observation group was significantly lower than in the control group(P＜0.05).No statistically sig-nificant differences were observed in cTNM,ypTNM,and TRG between the two groups(P＞0.05).By comparing the gross specimens of the two groups,it was observed that the mucosal and mesenteric congestion and edema of the intestinal wall in the control group were more pronounced than in the observation group.Meanwhile,HE staining showed a large number of inflammatory cells infiltration in the tumor tissue space of the control group specimens,while the specimens of the observation group had loose tissue with scattered inflammatory cells.Conclusion Jisheng Wumei Decoction retention enema can significantly reduce the incidence of radiation proctitis during the nCRT treatment process,reduce the discomfort of patients during treatment,and raise patient compliance,which is worth promoting and applying in clinical practice.