局部进展期直肠癌术前调强适形放疗联合同步化疗效果评价  

Efficacy evaluation of preoperative intensity-modulated radiotherapy combined with concurrent chemotherapy in patients with locally advanced rectal cancer

作　　者：张继东[1] 贾宁 刘楷东 刘勇[1] 韩晓栋[1] 麻富卯[2] Zhang Jidong;Jia Ning;Liu Kaidong;Liu Yong;Han Xiaodong;Ma Fumao(Department of Radiation of Enterocoelia and Pelvis 2,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China（Zhang JD,Jia N,Liu KD,Liu Y,Hart XD;Department of Radiation of Enterocoelia and Pelvis 1,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院放疗腹盆二病区,太原030013 [2]山西省肿瘤医院放疗腹盆一病区,太原030013

出　　处：《肿瘤研究与临床》2018年第6期391-395,共5页Cancer Research and Clinic

摘　　要：目的 评价局部进展期直肠癌（LARC）经术前调强适形放疗（IMRT）同步联合mFOLFOX6方案化疗的效果及不良反应.方法 选择2010年6月至2012年12月在山西省肿瘤医院接受术前IMRT联合化疗治疗的LARC患者86例,采用随机数字表法分为两组,mFOLFOX6方案同步化疗46例（mFOLFOX6组）,5-氟尿嘧啶（5-Fu）注射液单药同步化疗40例（5-Fu组）. IMRT靶区总剂量45～54 Gy,分25次完成.观察两组患者近期疗效、放化疗不良反应,分析两组生存及复发转移情况.采用χ2检验或Fisher确切概率法进行计数资料组间比较,应用Kaplan-Meier法计算生存率,行Log-rank检验.结果 总体随访率为97.67 %（84/86）.两组手术切除率、病理完全缓解（pCR）率、3年总生存（OS）率差异均无统计学意义（93.5 %比80.0 %、6.5 %比0、87.0 %比70.0 %,均P＞0.05）. mFOLFOX6组术前降期率、3年无瘤生存（DFS）率、无远处转移生存（DMFS）率均优于5-Fu组（58.7 %比32.5 %、79.1 %比50.0 %、89.1 %比72.5 %,均P＜0.05）.结论 术前IMRT联合同步mFOLFOX6方案化疗,能够降低LARC患者的术前分期,提高3年DFS率、DMFS率;不良反应有增加,但可耐受.Objective To evaluate the efficacy and adverse reactions of preoperative intensity-modulated radiotherapy （IMRT） combined with mFOLFOX6 chemotherapy regimen for locally advanced rectal cancer （LARC）. Methods A total of 86 patients with LARC who received preoperative IMRT combined with chemotherapy in Shanxi Provincial Cancer Hospital from June 2010 to December 2012 were enrolled. The patients were randomly divided into 2 groups according to the random number table method. Forty-six patients were treated with mFOLFOX6 regimen （mFOLFOX6 group） and 40 patients were treated with fluorouracil （5-Fu） single drug injection （5-Fu group）. The total dose of IMRT target region was 45-54 Gy, 25 times in total. Short-term efficacy, adverse reactions, survival and metastasis were evaluated respectively. χ 2test or Fisher test were used to compare the count variable. Kaplan-Meier method was used to calculate the survival rates and Log-rank was used to detect. Results The total follow-up rate was 97.67 % （84/86）. There were no statistical differences in the rate of resection （93.5 % vs. 80.0 %）, pathological complete remission （pCR） rate （6.5 % vs. 0） and 3-year overall survival （OS） rate （87.0 % vs. 70.0 %） in the mFOLFOX6 group and 5-Fu group respectively （all P 〉 0.05）. Down-staging rate, 3-year disease free survival （DFS） rate and distant metastasis free survival （DMFS） rate in the mFOLFOX6 group were significantly higher than those in 5-Fu group （58.7 % vs. 32.5 %, 79.1 % vs. 50.0 %, 89.1 % vs. 72.5 %, all P 〈0.05）. Conclusions Preoperative IMRT combined with mFOLFOX6 regimen can decrease the preoperative staging of LARC patients, improve 3-year DFS rate and DMFS rate. The adverse reactions may increase, but it is tolerant.

关 键 词：直肠肿瘤 放射疗法 调强适形 药物疗法 联合 

分 类 号：R735.37[医药卫生—肿瘤]