Ⅱ＋Ⅲ期直肠癌根治术后卡培他滨单药±奥沙利铂同期放化疗疗效对比  

Comparison of concurrent chemoradiotherapy with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation

作　　者：冯燕茹[1] 金晶[1] 王鑫[1] 肖琴[1] 王维虎[1] 王淑莲[1] 刘跃平[1] 宋永文[1] 任骅[1] 房辉[1] 李宁[1] 李晔雄[1] 刘新帆[1] 余子豪[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021

出　　处：《中华放射肿瘤学杂志》2014年第3期199-204,共6页Chinese Journal of Radiation Oncology

基　　金：北京希望马拉松专项基金资助（LC2011A11）;吴阶平医学基金会临床科研专项资助基金（320.6750.10074）

摘　　要：目的 比较Ⅱ、Ⅲ期直肠癌根治术后卡培他滨±奥沙利铂同期放化疗疗效.方法 回顾分析2002-2010年分别接受卡培他滨术后同期放化疗（单药组,427例）和奥沙利铂＋卡培他滨术后同期放化疗（双药组,248例）的临床资料.治疗模式均为全直肠系膜切除术＋同期放化疗±辅助化疗.放疗方法为真骨盆45.0～50.4 Gy分25次.结果 采用倾向评分配比法按1∶1平衡基线特征后产生单双药组各248例,其中单药、双药组5年样本数分别为81、104例.匹配后单、双药组的5年OS （78.1％∶74.9％）、DFS （74.4％∶67.9％）、LRC （94.5％∶ 92.8％）和DMFS （77.1％∶ 70.9％）均相近（P=0.547、0.292、0.484、0.364）,但双药组3、4级不良反应发生率显著高于单药组（38.3％∶24.6％,P=0.001）.结论 Ⅱ、Ⅲ期直肠癌根治术后卡培他滨＋奥沙利铂同期放化疗疗效未优于卡培他滨单药同期放化疗,而不良反应增加.单药卡培他滨同期放化疗仍为标准方案.Objective To compare the efficacy of concurrent chemoradiotherapy （CCRT） with capecitabine and oxaliplatin versus capecitabine alone in stage Ⅱ/Ⅲ rectal cancer patients after radical operation.Methods A retrospective analysis was performed on the clinical data of 675 patients with stage Ⅱ/Ⅲ rectal cancer who received postoperative concurrent chemoradiotherapy （CCRT） with capecitabine （CAP group,n =427） or capecitabine and oxaliplatin （CAPOX group,n =248） from 2002 to 2010.The treatment modality was total mesorectal excision ＋ CCRT ± adjuvant chemotherapy.Radiotherapy was delivered to the true pelvis at a dose of 45.0-50.4 Gy/25 fractions.Results The propensity score matching method （1 ∶ 1） was applied to balance the baseline characteristics and assign 248 patients to each group.The 5-year sample sizes for CAP group and CAPOX group were 81,104.There were no significant differences between the two groups in 5-year overall survival （78.1% vs.74.9%,P =0.547）,disease-free survival （74.4% vs.67.9%,P =0.292）,locoregional control （94.5% vs.92.8%,P =0.484）,and distant metastasis-free survival （77.1% vs.70.9%,P =0.364）.But grade 3/4 toxicities occurred in 24.6% of patients in the CAP group,versus 38.3% in the CAPOX group （P =0.001）.Conclusions CCRT with oxaliplatin and capecitabine has no survival advantage over CCRT with capecitabine alone and increases the incidence of toxicities in stage Ⅱ/Ⅲ rectal cancer patients after radical operation.CCRT with capecitabine alone is still the standard regimen.

关 键 词：直肠肿瘤 外科学 外科学 全直肠系膜切除术 直肠肿瘤 放化疗法 化学疗法 卡培他滨 奥沙利铂 

分 类 号：R735.37[医药卫生—肿瘤]