体部伽玛刀联合微波加热治疗直肠癌术后局部复发的临床观察

Clinical observation of body gamma knife radiotherapy combined with microwave hyperthermia for local recurrent rectal cancer

目的：评价体部伽玛刀联合微波加热治疗对直肠癌术后局部复发患者的临床疗效及毒副反应：方法：对直肠癌术后局部复发的36例患者应用体部伽玛刀联合微波加热治疗。伽玛刀治疗方案：50％～80％处方剂量线，4～6Gy／次，每周5次，总剂量36～42Gy，生物等效剂量56～67Gy。微波加热治疗方案：伽玛刀治疗期间予以微波加热治疗，每周2次，共4次：每次热疗均在伽玛刀治疗前进行，热疗温度保持在40～43℃范围，持续加热时间1．5～2h。治疗结束后1个月复查盆腔CT。结果：完全缓解7例，部分缓解25例，稳定3例，进展1例，近期总有效率88．9％。1、2和3年生存率分别为100．0％、83．3％和60．8％。主要毒副反应为下消化道反应，其中Ⅲ级反应2例。其余均为Ⅰ～Ⅱ级。结论：体部伽玛刀联合微波加热治疗直肠癌术后局部复发患者的疗效好，毒副反应轻。

Objective：To evaluate the clinical effects and side reactions of body gamma knife radiotherapy combined with microwave hyperthenmia for local recurrent rectal cancer. Methods：Thirty-six patients with local recurrent rectal cancer were treated by body gamma knite radiotherapy combined with microwave hyperthermia. Body gamma knife radiotherapy project received total dose from 36 to 42Gy, biological effective dose（ BED）56-67Gy,4-6Gy/fraction（50-80% dosage curve）,5 fractions per week. Microwave hyperthermia project that were treated by microwave hyperthermia befor body gamnm knife radiotherapy. It received total 4 fractions microwave hyperthermia during body gamma knife radiotherapy, 2 fractions per week. The temperature of microwave hyperthermia was maintained at 40-43℃ for 1.5-2 hours. Pelvic of patients were checked with CT1 month later after the treatment. Results：Seven patients were complete response（ CR）, 25 patients were partial response（PR）. The total response rate was 88.9% （CR ＋ PR）. The 1,2,3 year survival rate was 100% ,83.3% and 60. 8%. The main toxicity was digestive tract reactions. Two patients occurred acute toxicities of grade Ⅲ. The other patients occurred acute toxicities of grade Ⅰ- Ⅱ. Conclusion： Body gamma knife radiotherapy combined with microwave hyperthermia for local recurrent rectal cancer patients is effective and the acute toxicities are mild.