26例低位局部进展期直肠癌术前加量IMRT临床观察  

Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer

作　　者：刘其腾 冯林春 贾宝庆 杜晓辉 刘洪一 戴广海 陈静 杨咏强[5] 温珂 王运来 杨涛 高玉艳 Liu Qiteng;Feng Linchun;Jia Baoqing;Du Xiaohui;Liu Hongyi;Dai Guaaghai;Chen Jing;Yang Yongqiang;Wen Ke;Wang Yunlai;Yang Tao;Gao Yuyan(Department of Radiation Oncology（Current Affiliation ： Department of Radiation Oncology,Beijing Luhe Hospital affiliated to Capital Medical University,Beijing 101149,China;Department of General Surgery 11;Department of General Surgery I（Du XH）,Department of Medical Oncology;Chinese PLA General Hospital,Beijing 100853,China;Department of Radiation Oncology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Radiation Oncology,Chinese PLA 302 Hospital,Belling 100039,China;Department of Radiation Oncology,Beijing Luhe Hospital affiliated to Capital Medical University,Beijing 101149.China)

机构地区：[1]解放军医学院肿瘤学系解放军总医院放疗科,北京100853 [2]解放军医学院肿瘤学系解放军总医院普外二科,北京100853 [3]解放军医学院肿瘤学系解放军总医院普外一科,北京100853 [4]解放军医学院肿瘤学系解放军总医院肿瘤内科,北京100853 [5]苏州大学第二附属医院放疗科,江苏215004 [6]解放军第三О二医院放疗科,北京100039 [7]首都医科大学附属北京潞河医院放疗科,北京101149

出　　处：《中华放射肿瘤学杂志》2018年第10期906-910,共5页Chinese Journal of Radiation Oncology

基　　金：科技部国家重点研发计划（2016YFC0105712）

摘　　要：目的探讨低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案的可行性及治疗效果。方法选取2015-2016年301医院26例局部晚期直肠癌患者，肠镜下肿瘤下缘距肛缘5cm内。放疗剂量分割模式直肠肿瘤及转移淋巴结为58．75 Gy分25次（2．35 Gy／次），盆腔淋巴引流区为50 Gy分25次，同步卡培他滨化疗（825 mg／m^2，2 7欠／d，5天／周）5周。同步放化疗结束后休息1周，继续辅以1个周期卡培他滨化疗（1 250 mg／I／1。，2次／d，连续14 d）。同步放化疗结束后6。8周行直肠TME。研究主要终点为获得ypCR及保肛手术率，次要终点为急性放化疗反应、TN降期率及术后并发症。结果26例患者均完成新辅助放化疗，其中25例患者已行手术治疗，1例患者因肛周水肿无法手术。术后ypCR率达32％（8／25），保肛手术率为60％（15／25）；TN总降期率为92％（23／25），R0切除率为100％。放化疗期间24例患者发生1、2级不良反应，2例患者发生3级放射性皮炎，未见i〉4级急性不良反应。术后输尿管损伤1例，肠梗阻1例。结论低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案安全可行，ypCR、Ro切除率及保肛手术率达到了预期效果，长期生存是否获益有待今后进一步研究。临床试验注册 中国临床试验注册中心，注册号：ChiCTR-ONC-12002387。Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy （SIB-IMRT） combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer. Methods Between 2015 and 2016, 26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer, which was located within 5 cm from the anal verge, were enrolled in this investigation. Dose fractionation pattern was delivered ：58.75 Gy in 25 fractions （2. 35 Gy/fraction） for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy （825 mg/m2, bid d 1-5 weekly）.One cycle of capecitabine （1 250 mg/m2, twice daily, d 1-14） was given at one week after the completion of chemoradiotherapy （CRT）.Total mesorectal excision （TME） was performed at 6 to 8 weeks after the completion of CRT. The primary endpoints included pathological complete response rate （ypCR） and sphincter-preserving rate. The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications. Results Twenty-six patients successfully completed neoadjuvant CRT, 25 of them underwent surgical resection and one patient failed to receive surgery due to perianal edema. Postoperative ypCR rate was 32% （ 8/25）, the sphincter-preserving rate was 60% （15/25） ,the tumor downstaging rate was 92%（23/25） and the R0 resection rate was 100%.During the period of CRT, grade 1 and 2 adverse events occurred in 24 patients, grade 3 radiation dermatitis was noted in 2 cases. No≥ grade 4 acute adverse event was observed. Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient. Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locally- advanced low rectal cancer, which yields e

关 键 词：直肠肿瘤:肛门肿瘤 新辅助放化疗 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]