| 姚波,王雅棣,路娜,刘清智,陈点点.局部复发直肠癌超常规大分割同步放化疗疗效分析[J].中华放射医学与防护杂志,2015,35(8):603-606,627 |
| 局部复发直肠癌超常规大分割同步放化疗疗效分析 |
| Outcomes for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresction |
| 投稿时间：2015-01-09 |
| DOI：10.3760/cma.j.issn.0254-5098.2015.08.010 |
| 中文关键词: 直肠腺癌 局部复发 大分割放疗 同步放化疗 疗效 |
| 英文关键词:Rectal adenocarcinoma Local recurrence Hypofractionation Concurrent chemoradiotherapy Efficacy |
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| 中文摘要: |
| 目的 分析局部复发不能手术切除的直肠癌患者,采用超常规大分割放疗同步口服卡培他滨化疗的疗效、影响因素及不良反应。方法 选取2006年1月至2013年1月,本院收治的52例直肠腺癌术后局部复发的患者,均采用调强放疗(IMRT)技术,照射复发肿瘤区,肿瘤中位剂量63.4 Gy(61.6~64.4 Gy),2.2~2.3 Gy/次,5次/周;13例进行盆腔淋巴结预防照射采用同步补量IMRT技术,剂量45~50.4 Gy,1.8~2.0 Gy/次。全部患者均接受同步化疗,每天口服卡培他滨1 650 mg/m2,连续5 d/周。分析局部控制率(LC)、总生存率(OS)及不良反应。结果 全部患者完全缓解(CR)、部分缓解(PR)、稳定(SD)及局部进展(PD)分别为23.1%、38.5%、32.7%和5.8%。既往盆腔放疗与未放疗的有效率(CR+PR)分别为37.1%和71.1%(χ2=5.40,P<0.05); 单一区域复发疗效优于两个及以上区域复发者,有效率分别为81.8%和46.7%(χ2=6.63,P<0.05)。早期严重不良反应包括:3级皮肤反应19例(36.5%),3级血液学不良反应1例(1.9%)。4例患者晚期发生重度吻合口狭窄行横结肠造瘘。5年LC和OS分别为49.1%和23.1%。结论 局部复发直肠癌单纯局部大分割高剂量放疗同步口服卡培他滨化疗是可行的,早晚期不良反应可耐受,有较好的近期疗效和长期控制率。 |
| 英文摘要: |
| Objective To analyze the response rate and prognostic factors for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresection. Methods Totally 52 patients with locally recurrent rectal cancer received hypofractionated irradiation and concurrent chemotherapy from January 2006 to January 2013 were enrolled. All patients received intensity-modulated radiotherapy (IMRT). The median dose was 63.4 Gy (61.6-64.4 Gy) at 2.2-2.3 Gy/f, 5 f/week. Thirteen patients underwent prophylactic irradiation at lymph nodes region, the total dose of 45-50.4 Gy with conventional fraction and a simultaneous integrated boost was used. All patients received concurrent chemotherapy, capecitabine at 1 650 mg•m-2•d-1, divided into 2 times, 5 d/week. The variables were compared by the chi-square test or Fisher's exact test. Local control (LC) and overall survival (OS) were calculated with using the Kaplan-Meier method. Results For all patients, the clinical complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was 23.1%, 38.5%, 32.7% and 5.8%, respectively. The response rate (CR+PR) for patients with previous irradiation to pelvis and without were 37.1% and 71.1%, respectively (χ2=5.40, P<0.05);for patients with 1 and 2 or more recurrent subsites were 81.8% and 46.7%,respectively (χ2=6.63, P<0.05). Acute grade 3 skin and hematologic toxicities occurred in 19 patients (36.5%) and 1 patient (1.9%), respectively. None occurred grade 4 toxicity and none occurred grade 3 or more gastrointestinal and urologic toxicities. Four patients showed severe late toxicity of anastomotic stricture and performed a stoma at transverse colon. No other severe late toxicities were observed. The LC at 5 years was 49.1% and the OS was 23.1%. Conclusions For patients with locally recurrent rectal cancer, hypofractionated chemoradiotherapy without resection is an acceptable and effective regimen, the response rate and long-term outcomes are promising. |
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