VMAT联合XELOX方案术前治疗局部晚期直肠腺癌的临床观察  

Clinical Observation on Oxaliplatin Combined with VMAT in Treatment of Stage Ⅱ～Ⅲ Rectal Neoplasm

作　　者：曹玲[1] 杨永净[1] 石磊[1] 吴洪芬[1] 

机构地区：[1]吉林省肿瘤医院,吉林长春130012

出　　处：《中国肿瘤》2016年第6期487-490,共4页China Cancer

摘　　要：[目的]观察VMAT联合XELOX方案术前治疗局部晚期直肠腺癌的早期临床疗效及治疗不良反应,明确其在临床实践中的可行性。[方法]入组2012年3月至2014年9月符合入组条件的局部进展期直肠腺癌患者86例,予以术前放化疗。全组放疗采用VMAT技术,靶区剂量为：计划大体肿瘤靶体积（PGTV）：50Gy/25次,计划靶区（PTV）：45Gy/25次,1次/d,5次/周。同步化疗采用XELOX方案,具体如下：卡培他滨1600mg/m2/d,分两次口服,d1-14,22-25,奥沙利铂100mg/m^2,d1,22）。术后继续行XELOX方案化疗4个周期。[结果 ]全组86例患者均完成放疗。放化疗期间3-4级急性不良反应发生情况：血液学毒性：3-4级白细胞减少5例（5.8%）;3-4级血小板减少2例（2.3%）。非血液学毒性：3-4级腹泻13例（15.1%）。全组共85例患者完成手术,其中Dixon手术57例,Miles’手术26例,Hartmann手术1例,其他1例。低位直肠癌保肛率为50%（23/46）。82例（96.5%）患者R0切除。全组病理完全缓解率（p CR）20.0%（17/85）。局部T分期、N分期及临床分期降期率分别为82.4%、52.9%和76.5%。术后60天内无死亡病例。[结论]VMAT联合XELOX方案术前治疗局部进展期直肠腺癌可获得良好的p CR率及肿瘤降期率,不良反应可耐受,值得临床推广。[Purpose] To observe the early clinical efficacy and side effects of VMAT combined with XELOX for preoperative treatment in locally advanced rectal adenocarcinoma,and verify the feasibility of the VMAT combined with XELOX in clinical practice. [Methods] A total of 86 cases of patients with locally advanced rectal adenocarcinoma who met the inclusion criteria were en-rolled in our hospital from March 2012 to September 2014 and received preoperative chemoradio-therapy. The radiotherapy of the whole group used VMAT technology and the target dose was PGTV：50Gy/25 times and PTV：45Gy/25 f. The concurrent chemotherapy used the XELOX program and was specific as follows：capecitabine 1600mg/m-2/day,twice a day,d1 -14,22 -35,oxaliplatin 100mg/m^2,d1,22. The XELOX chemotherapy program continued for 4 cycles postoperatively. [Results] All patients completed radiotherapy. The occurrences of grade 3-4 acute adverse reactions during the chemoradiotherapy were as follows：the hematologic toxicity：there were 5 cases with grade 3-4neutropenia（5.8%）;and 2 cases with grade 3-4 thrombocytopenia（2.3%）;non-hematologic toxicity：there were 8 cases with grade 3-4 diarrhea（9.3%）. 85 patients in the whole group completed the operation. Among them,there were 57 cases receiving Dixon surgery,26 cases Miles＇ surgery,1case Hartmann surgery,and 1 case other surgery. The probability of anus reservation of low rectal carcinoma was 50%（23/46）. There were 82 cases（96.5%） receiving R0 resection. The p CR rate of the whole group was 20.0%（17/85）. The local T-level downstaging rate was 82.4%（70/85）,the N downstaging rate was 52.9%（45/85）,and downstaging rate of clinical stage was 76.5%（65/85）.There were no deaths within 60 days after operation. [Conclusion] VMAT combined with XELOX for preoperative treatment in locally advanced rectal adenocarcinoma obtain excellent p CR rate and tumor downstaging rates,the adverse reactions were tolerable,and thus the treatment was worthy of clinical promotion.

关 键 词：直肠肿瘤 旋转容积调强放疗 奥沙利铂 病理降期 

分 类 号：R735.37[医药卫生—肿瘤]