加速超分割再程放疗同步卡培他滨治疗直肠癌术后局部区域复发  

Efficacy observation of accelerated hyperfractionation recourse radiotherapy plus concurrent capecitabine in the treatment of locoregional recurrent rectal cancer

作　　者：张建东[1] 戴勇[2] 于金明[4] 邵震宇[3] 

机构地区：[1]山东大学附属千佛山医院肿瘤放疗科,济南250014 [2]山东大学齐鲁医院普通外科 [3]山东大学齐鲁医院放疗科 [4]山东省肿瘤医院放疗科

出　　处：《中华医学杂志》2010年第14期982-984,共3页National Medical Journal of China

基　　金：山东省科技攻关项目（2009gg10002046）

摘　　要：目的评价加速超分割（CAF）同步卡培他滨再程放疗治疗直肠癌术后局部区域复发的局部控制率、生存期和毒副作用。方法从2004年6月至2008年1月对53例直肠癌术后辅助放疗后局部区域复发患者，应用CAF再程放疗同步卡培他滨化疗。放疗3D-CRTCAF，1．2Gy／f，2次／d，2次间隔6h。同步行卡培他滨850mg／m2，2次／d，d1-14，d22-35。36Gy／30f／3 w后CT复查，评价能否手术，不能手术切除者根据肿瘤退缩情况重新勾画靶区，总Dr52．8—57．6Gy。放疗期间化疗2周期，结束后化疗2周期。结果完全缓解率9．8％，部分缓解率45．1％，有效率54．9％，无变化29．4％，进展15．7％。对部分缓解的23例患者进行影像学评价，其中23．5％患者接受了手术切除，RO、R1切除率分别为21．6％和1．9％。中位疾病进展时间10．5个月，全组1年生存率84．3％，2年生存率61．1％。结论CAF再程放疗同步卡培他滨治疗直肠癌术后局部区域复发可提高局部控制率、增加手术切除率和R0切除率，延长生存期，生活质量提高，毒副反应可耐受。Objective To evaluate the efficacy of accelerated hyperfractionation（CAF） radiotherapy plus concurrent capecitabine in the treatment of locoregional recurrent rectal cancer. Methods Between June 2004 and January 2008, 53 patients with locoregional recurrent rectal cancer were treated with CAF 1.2 Gy/f, 2 f/d plus concurrent capecitabine at an oral dosage of 825 mg/m2 bid on each day of radiotherapy period. The first daily dose was applied at 2 h pre-irradiation, dl-14 and d22-35. After a regimen of 36 Gy/ 30 f/3 w, the feasibility of surgical resection was then evaluated by CT. Patients unsuitable for surgical resection continued CAF. And the total dose was 52. 8-57.6 Gy. Results The complete response rate was 9. 8%, the partial response rate 45.1%, the effective rate 54.9%, the no-change rate 29.4%, the progression rate 15.7%, the surgical resection rate 23.5% and the R0, R1 resection rates 21.6% and 1.9% respectively. The Time to Progression was 10. 5 months, 1-year survival rate was 84. 3%, 2-year survival rate was 61.1%. Quality of life improved in treatment group. Toxic and adverse effects were gastrointestinal and hematological toxicities. There was no treatment-related mortality. Conclusion The 3- dimensional conformal radiotherapy plus concurrent chemotherapy may be an effective and well-tolerated regimen in patients with postoperative locoregional recurrent or mestastatic rectal cancer.

关 键 词：直肠肿瘤 肿瘤复发 局部 放射疗法 化学治疗 预后 

分 类 号：R735.37[医药卫生—肿瘤]