| 杨咏强,冯林春,贾宝庆,曲宝林,马林,刘洪一,王运来,葛瑞刚,陈静,蓝玉玲,王竞.局部中晚期直肠癌术前同期加量调强放疗前瞻性临床研究的初步结果[J].中华放射医学与防护杂志,2013,33(5):512-515 |
| 局部中晚期直肠癌术前同期加量调强放疗前瞻性临床研究的初步结果 |
| Preliminary results of the prospective clinical trial of preoperative concomitant boost intensity-modulated radiotherapy in locally advanced rectal cancer |
| 投稿时间：2013-03-23 |
| DOI：10.3760/cma.j.issn.0254-5098.2013.05.014 |
| 中文关键词: 直肠癌 调强放疗 卡培他滨 |
| 英文关键词:Rectal cancer Intensity-modulated radiation therapy Capecitabine |
| 基金项目: |
| 作者 | 单位 | E-mail | | 杨咏强 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 冯林春 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | 301flc@163.com | | 贾宝庆 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院肿瘤外科 | | | 曲宝林 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 马林 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 刘洪一 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院肿瘤外科 | | | 王运来 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 葛瑞刚 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 陈静 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 蓝玉玲 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | | | 王竞 | 100853 北京, 解放军医学院肿瘤学系 解放军总医院放疗科 | |
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| 中文摘要: |
| 目的 评估对Ⅱ~Ⅲ期可手术切除的直肠癌患者行术前同期加量调强放疗(SIB-IMRT)并同步口服卡培他滨化疗的可行性、安全性及近期疗效。 方法 2012年8月至2013年5月间共13例Ⅱ~Ⅲ期可手术切除的直肠癌患者接受术前调强放疗,给予肿瘤原发病灶及转移淋巴结56.25 Gy/25次 (2.25 Gy/次),高危复发区域和区域淋巴引流区50 Gy/25次 (2.0 Gy/次),同时口服卡培他滨同步化疗(825 mg/m2,2次/d, 5 d/周×5周)。放化疗结束后4~8周患者接受全直肠系膜切除术(TME)。研究主要终点为病理完全缓解率(ypCR率)、TNM降期率、急性期不良反应及术后并发症发生率,次要终点为保肛手术率。 结果 所有患者顺利完成术前同步放化疗并接受TME, TNM降期率为10/13,其中T降期率为9/13,N降期率为4/6, ypCR率为 3/13。放化疗期间不良反应全部为1~2级,包括2级骨髓抑制5例,1级骨髓抑制4例,1级腹泻2例。1例患者术后出现膀胱瘘。保肛手术率为10/13。 结论 局部中晚期直肠癌患者行SIB-IMRT并口服卡培他滨的术前同步放化疗方案的初步结果表明其疗效好、安全可行、不良反应发生率低。 |
| 英文摘要: |
| Objective To evaluate the feasibility, safety, and short-term efficacy of preoperative capecitabine and simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) in patients with locally advanced rectal cancer. Methods Between August 2012 and May 2013, a total of 13 patients with resectable stage Ⅱ or Ⅲ rectal cancer received capecitabine (825 mg/m2 P.O, twice a day, 5 d/week for 5 weeks) and SIB-IMRT delivering 56.25 Gy (2.25 Gy/fraction) to the gross tumor while simultaneously delivering 50 Gy (2.0 Gy/fraction) to the regional lymph nodes and areas at risk for harboring microscopic disease. Total mesorectal excision was scheduled 4 to 8 weeks after the completion of chemoradiation. The primary endpoints included pathological complete response rate (ypCR), tumor downstaging, toxicity and postoperative complications. The secondary endpoint included the rate of sphincter-sparing surgery. Results All patients completed chemoradiation with strict compliance to the protocol schedule and then went on to surgical resection. Three patients had no residual tumor in the surgical specimen. Downstaging of the primary tumor and lymph nodes was observed in 9 and 4 patients, respectively. Grade 1 or 2 toxicities included leucopenia, thrombocytopenia and diarrhea. One patient developed vesical fistula after surgery. Ten patients underwent sphincter-sparing procedures. Conclusions Preoperative chemoradiation with capecitabine and SIB-IMRT can be safe and well tolerated for patients with locally advanced rectal cancer and the short term outcomes could be promising. |
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