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高剂量放疗联合化疗治疗直肠癌的临床分析
作者:张术  王小豪  肖巍魏  王俏镟  曾智帆  丁培荣  陈功  潘志忠  万德森  高远红 
单位:华南肿瘤学国家重点实验室  中山大学肿瘤防治中心放射治疗科  广东 广州 510060 华南肿瘤学国家重点实验室  中山大学肿瘤防治中心结直肠科  广东 广州 510060 
关键词:直肠肿瘤/放射疗法 直肠肿瘤/药物疗法 放射治疗剂量 存活率 综合疗法 治疗结果 预后 
DOI:R735.3+7;R730.55
出版年,卷(期):页码:2018,33(2):102-107
摘要:

目的 通过分析高剂量放疗联合化疗治疗放弃手术的直肠癌患者的疗效及不良反应,探讨高剂量放疗治疗特定直肠癌人群的可行性。方法 52例放弃手术的直肠癌患者接受高剂量放疗联合化疗。放疗技术采用三维适形放疗(three dimensional conformal radiation therapy,3D-CRT)或调强放射治疗(intensity modulated radiation the-rapy,IMRT);治疗前明确放弃手术者给予一程高剂量放疗:大体肿瘤靶区(gross tumor volume,GTV)60~70 Gy/30~35 F (中位66 Gy),临床靶区(clinical target volume,CTV)45~50 Gy/25 F;新辅助或诱导放化疗后未达到临床完全缓解(clinical complete response,cCR)而又放弃手术者给予二程推量放疗:第一程GTV 45~50 Gy/25 F、CTV 45~46 Gy/25 F,第二程推量放疗GTV 30 Gy/15 F,中位总剂量80 Gy,两程放疗间隔期中位时间71 d。分析全组、局部进展期直肠癌亚组以及全程治疗后获得临床完全缓解亚组患者的局部复发率或进展率、生存率及不良反应。结果 中位随访30个月,全组3年无局部进展生存率(local progression free survival,LPFS)、无进展生存率(progression free survival,PFS)和总生存率(overall survival,OS)分别为80.4%、65.7%和84.2%。局部进展期患者3年局部进展率13.6%,3年LPFS、PFS和OS分别为84.6%、68.1%和87.5%。治疗后获cCR者局部复发率12.9%,3年LPFS、PFS和OS分别为85.2%、73.9%和96.8%。无4~5级严重急性不良反应发生,远期需要医疗干预的放射性直肠炎发生率为5.8%。结论 高剂量放疗联合化疗治疗放弃手术的特定直肠癌人群可获得满意的临床疗效,急性及远期放疗毒性可以接受。

Objective To analyze the efficacy and adverse effect of high-dose radiotherapy combined with chemotherapy in treating rectal cancer patients who failed to receive surgical treatment, and to explore the feasibility of high dose radiation in the special group of rectal cancer. Methods Fifty-two cases of rectal cancer patients who abandoned surgical treatment were treated with high-dose radiotherapy combined with chemotherapy. Radiotherapy includes three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT). Patients who gave up surgery before any treatment received one course of high-dose radiotherapy[Gross tumor volume (GTV) 60-70 Gy/30-35 F with a median dose of 66 Gy, clinical target volume (CTV) 45-50 Gy/25 F]. For patients who did not reach clinical complete response (cCR) after neoadjuvant or induced chemoradiotherapy and then abandoned surgical treatment, 2 courses of radiotherapy were administered:GTV 45-50 Gy/25 F and CTV 45-46 Gy/25 F for the 1st course, and GTV 30 Gy/15 F for the 2nd course. The median total dose was 80 Gy and the median interval between the 2 courses was 71 d. The local recurrence or local progression rate, survival rate and therapeutic toxicity were analyzed for all-patient group, local advanced rectal cancer subgroup, and cCR subgroup. Results The median follow-up duration was 30 months. 3-year local progression free survival (LPFS), progression free survival (PFS) and overall survival (OS) of all patients were 80.4%, 65.7% and 84.2% respectively. For locally advanced patients, 3-year LPFS, PFS and OS were 84.6%, 68.1% and 87.5% respectively. For those who achieved cCR after high dose chemoradiotherapy, local recurrence rate was 12.9%, and 3-year LPFS, PFS and OS were 85.2%, 73.9% and 96.8% respectively. No 4-5 level severe acute radiation adverse reactions was observed. Moreover, only 5.8% of all patients developed chronic radiation proctitis that needs medical intervention. Conclusion High-dose radiation combined with chemotherapy can achieve satisfactory clinical outcome in rectal cancer patients who refuse surgery with tolerable acute and long-term therapeutic side effect.

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