局部晚期直肠癌新辅助调强放疗联合卡培他滨化疗67例疗效观察  

Clinical Efficacy of Preoperative Intensity-modulated Radiotherapy(IMRT) with Oral Capecitabine in 67 cases with Locally Advanced Rectal Cancer

作　　者：丁叔波[1] 胡望远[1] 黎萍[1] 杜金林[1] 王建平[1] 张天明[1] 施红旗[1] 潘海卿[1] 

机构地区：[1]金华市中心医院,浙江金华321000

出　　处：《肿瘤学杂志》2015年第5期411-414,共4页Journal of Chinese Oncology

基　　金：金华市科学技术研究计划重点项目(编号2012-3-010)

摘　　要：[目的]评估局部晚期直肠癌新辅助调强放疗联合卡培他滨化疗安全性及疗效。[方法]对临床分期为T3/T4或淋巴结阳性的67例直肠腺癌患者进行新辅助调强放疗联合化疗。调强放疗方案为原发病灶及转移淋巴结外放1cm,放疗剂量55Gy,每次2.2Gy,盆腔放疗剂量为45Gy,每次1.8Gy。卡培他滨1650mg/（m2·d）分2次于放疗d1~14及d22~35口服,手术于放化疗结束后6~8周进行。[结果]除1例因3级腹泻停止放化疗外余均完成同步放化疗。同步放化疗不良反应：3级腹泻4例（6.0%）,3级放射性皮炎3例（4.5%）,无4级不良反应发生。术后15例（22.4%）达病理完全缓解。术后30d内无死亡病例,3例（4.5%）出现吻合口瘘,2例（3.0%）会阴部切口感染,1例（1.5%）出现肠梗阻。[结论]直肠癌新辅助调强放化疗安全,耐受性好,病理完全缓解率高。[Purpose ] To assess the safety and efficacy of preoperative intensity-modulated radio- therapy（IMRT） combined with oral capecitabine in locally advanced rectal cancer. [Methods] A total of 67 patients with T3 to T4 and/or N ＋ rectal adenocarcinoma received preoperative IMRT with concurrent capecitabine.IMRT was delivered 55Gy（2.2Gy/day for 5 weeks） to the gross tumor volume plus lcm while simultaneously with 45Gy （1.8Gy/day for 5 weeks） to the regional lymph nodes and organs at risk for harboring microscopic disease.Capecitabine（1650 mg/m2.d） was given twice daily d1-14 and d22-35 during radiotherapy. Surgical resection was scheduled 6-8 weeks after chemoradiation. [Results ] AI1 patients received chemoradiation except 1 of them interrupted ra- diotherapy due to diarrhea grade 3. Four（6.0%） patients occurred diarrhea grade 3. Three （4.5%） patients developed radio dermatitis grade 3. There was no grade 4 toxicity observed. All patients underwent surgery. 15 patients （22.4%） had a pathologically complete response （pCR）. There was no death in the first 30 days postoperation. Postoperative complications included three cases （4.5%） of anastomotic leakage ,two cases （3.0%） of pelvic wound infection and one case （1.5%） of ileus. [Conclusion] Preoperative IMRT and chemotherapy is safe and well tolerable,and offer a high rate of oCR for patients with locally advanced rectal cancer.

关 键 词：直肠肿瘤 调强放疗 药物疗法 

分 类 号：R735.37[医药卫生—肿瘤]