局部晚期和(或)复发性直肠癌热疗加放疗近期疗效观察

Radiofrequency Hyperthermia Plus Radiotherapy and Radiation Alone for Locally Advanced and Recurrent Recatal Cancer

目的 :探讨射频热疗结合放射治疗对局部晚期和 (或 )复发性直肠癌的安全性及初步疗效 ,并与单纯放疗的病人比较。方法 :分析本院 1998～ 2 0 0 2年收治的 83例中晚期直肠癌患者。其中 5 1例给予单外疗 (单放组 ) ,予全盆腔放疗 ,用 8MV -X线 ,放疗剂量 (DT) 4 0～ 4 6Gy ,局部缩野DT2 0～ 2 6Gy ,总DT6 0～ 6 6Gy ,均为常规分割。 32例予外放疗结合射频热疗 (热放组 ) ,放疗方法及剂量同单纯放疗组。热疗设备选用ZRL -Ⅰ型射频热疗机。 2例为腔内热疗 ,其余均为腹部透热 ,提升肿块局部温度达 4 1°～ 4 3℃ ,并维持 4 5～ 6 0分钟 ,热疗 2次 /周 ,每个疗程 6次。结果 :(1)症状的改变 :对有疼痛症状者采用自身对比法 ,热放组共 2 3例 ,疼痛缓解率 91.3%。单放组 4 0例伴有疼痛 ,症状缓解率 6 7.5 % (P <0 .0 5 )。热放组 18例便血 ,缓解率88.9% ,单放组 31例 ,缓解率 6 1.3% (P <0 .0 5 )。 (2 )瘤体的变化情况 :以治疗结束 1个月后的腹盆腔CT检查结果为准 ,热放组有效率为 6 2 .5 % (2 0 / 32 )。单放组有效率 4 3.1% (2 2 / 5 1) ,无显著差异 (P >0 .0 5 )。 (3)生存率 :热放组 1年生存率为87.5 % ,单放组为 84 .3% ,无显著差异 (P >0 .0 5 )。 (4 )急性不良反应 :热放组肠道放射反应 18例 (5 6 .3% )

Objective: To evaluate the efficacy and side-effect of radiotherapy with radiofrequency hyperthermia(H) and radiotherapy alone (R) for locally advanced un-resectable or recurrent, rectal cancer. Methods: Eighty-three patients were treated with combined radiation therapy and radiofrequency hyperthermia or radiation alone in our hospital, from 1998-2002 were retrospectively studied. Fifty-one patients received radiotherapy alone by conventional pelvic 40-46Gy, a further 20-26Gy was given to a small volume to a total dose of 60-66Gy. Thirty-two patients received hyperthermia plus radiotherapy. Their radiation methods were same from the radiotherapy group.They received hyperthermia with ZRL-Ⅰ RF, the temperature was increased and maintained at 41-43℃ for 45-60 minutes within one hour following irrdiation. Hyperthermia was given twice per week with 6 sessions hyperthermia. Results: (1) The local pain of the H+R group was relieved in 21 of 23 patients. The R group was 27 of 40 patients. (2) The tumor disappeared in 3 cases of and reduced in 17 cases of the H+R group, the tumor disappeared in 3 cases and reduced in 19 cases of the R group. The effective rate was 62.5% (20/32), 43.1% (22/51), respectively. (P>0.05) (3) The survival rate: the 1-year survival rate was 87.5% in the H+R group, the 1-year survival rate was 84.3% in the R group, there is no statistical significance. (4) Acute Side-effect: The incidence of rectal radiation reactions were 56.3% in the H+R group and 54.9% in the R group. The incidence of bladder radiation reactions were 6.3% in the H+R group and 5.9% in the R group. They were tolerated well. Conclusion: Combined H and R appears to a promising new approach for patients with wcally advanced un-resectable or recurrent rectal cancer and can increase the local control advanced malignancies.The side-effects were not increased. Long-term survival and possible specific injury should await further study.