三维适形放疗结合化疗治疗直肠癌术后复发的临床研究

Clincial study on three dimensionally planned boost radiotherapy in combination with chemotherapy for postoperative local recurrence rectal cancer

目的探讨三维适形放射治疗结合化疗治疗直肠癌术后复发的疗效.方法回顾性分析61例直肠癌术后复发患者采取首先给予常规放射治疗44 Gy/22次,再给予三维适形放射治疗加量3 Gy/次,共5～7次,肿瘤总量（DT）59～65 Gy/27～29次结合化疗（5-氟尿嘧啶0.75 g/m^2 ＋CF200 mg,d1～5和d29～33;顺铂40 mg/m^2,d1～3和d29～31）的疗效,生存分析采用Kaplan-Meier法.结果患者1、2、3年肿瘤局部控制率分别为86.9%、67.2%、37.7%;1、2、3年生存率分别为80.3%、62.3%、39.2%,中位生存期24.6个月;1、2、3年无瘤生存率分别为79.7%,52.5%、31.1%.急性放射反应主要是急性放射性肠炎和放射性膀胱炎,多为1～2级.结论三维适形放射治疗结合化疗可提高术后局部复发或转移直肠癌的控制率和生存率,改善其生存质量.

Objective To evaluate the treatment effect of stereotactic radiotherapy （SRT） in combination with chemotherapy for rectal cancer of postoperative local recurrence. Methods Sixty-one rectal cancer cases of postoperative local recurrence were treated with conventional radiotherapy plus 3D-CRT （44 Gy/22 Fx ＋ 15-21 Gy/5-7 Fx） in combination with chemotherapy （5-Fu 0.75 ＋ CF 200 mg for days 1-5 and days 29-33; Cisplatin 40 mg for days 1-3 and days 29-31 ）. Acute and late radiation syndrome and survival rates were observed, and survival analysis was carried out using Kaplan-Meier method. Results The local control rates were 86.9%, 67.2%, and 37.7%, for the first, second and the third years, respectively. Its corresponding survival rates and tumor-free survival rates in each year were estimated to be 80.3% ,62.3% ,39.2%, and 79.7% ,52.5%, and 31.1%, respectively. The median survival time was estimated to be 24.6 months. Acute radiation syndrome including enterititis, rectitis, and urocystitis were observed, and its degree varied from grade 1 to grade 2. Conclusion Conventional radiotherapy plus three dimensionally radiotherapy in combination with chemotherapy could be considered as an effective and feasible treatment for cancer patients of postoperative local recurrence.