中低位局部进展期直肠癌术前30Gy/10f短程放疗初步探讨  

Preliminary Investigation of preoperative 30Gy/10f Short Course Radiotherapy for Middle-lower Locally Advanced Rectal Cancer

作　　者：潘宏达[1] 王林[1] 詹天成[1] 彭亦凡[1] 顾晋[1] 

机构地区：[1]北京大学肿瘤医院,北京肿瘤医院,北京市肿瘤防治研究所,恶性肿瘤发病机制及转化研究教育部重点实验室

出　　处：《肿瘤学杂志》2015年第1期14-20,共7页Journal of Chinese Oncology

摘　　要：[目的]探讨中低位局部进展期直肠癌术前30Gy/10f短程放疗的治疗效果及预后因素分析。[方法]中低位局部进展期直肠癌患者282例。总剂量30Gy,分10次照射的术前短程放疗方案（30Gy/10f）,生物有效剂量为36Gy,照射方式为3D适形放疗。放疗后休息2~4周后行手术治疗。分析相关临床病理学因素对预后的影响。[结果]病理完全缓解率（yp CR）为5.7%（16/282）,术后病理降期率35.8%（101/282）。3年无病生存率为78.0%,局部复发率4.6%（13/282）。发生转移50例,无转移生存率82.3%。同时合并转移、复发1例。多因素分析表明：肿瘤分化程度、yp N分期、手术方式是影响3年无病生存率的独立因素。环周切缘状态和yp N分期是影响局部复发的独立因素。[结论]中低位局部进展期直肠癌术前应用30Gy/10f短程放疗可以获得良好的局部控制,是一种有效的新辅助治疗方案。[Purpose] To investigate the treatment effect and prognostic factors of preoperative 30Gy/10f short course radiotherapy for middle-lower locally advanced rectal cancer . [Methods ] Two hundred and eight-two patients with middle-lower locally advanced rectal cancer were studied. All the patients underwent preoperative radiotherapy with scheme recommended by Chinese Anti-Cancer Association. Total dose of 30Gy was divided into 10 fragments（30Gy/10f）,the biologically effective dose（BED） was 36Gy,3D conformal radiotherapy（3D-CRT） was used. The curative surgery was performed 2-d weeks after the preoperative radiotherapy. The prognostic effect of clinicopathological factors were analyzed retrospectively. [Results] The yield pathological complete response （ypCR） was 5.7%（16/282）,postoperative downstaging rate was 35.8%（101/282）. 3- year disease-free survival （DFS） was 78.0% ,local recurrence rate was 4.6%（13/282）,metastasis was found in 50 patients, 3-year metastasis-free survival was 82.3%. One patient developed synchronous local recurrence and metastasis. Multivariate analysis showed that differentiation,ypN stage,surgical type were the independent prognostic factors of 3-year DFS,and circumferential resection margin （CRM） state and ypN stage were the independent prognostic factors of local recurrence. [Conclusion] Middle-lower locally advanced rectal cancer with preoperative 30Gy/lOf short course radiotherapy might achieve satisfying treatment effect. Therefore,30Gy/10f short course radiotheraov is reliable and effective.

关 键 词：直肠肿瘤 术前放疗 短程放疗 预后 

分 类 号：R735.3[医药卫生—肿瘤]