三维适形放疗同步化疗治疗术后复发性直肠癌

Three-dimensional Conformal Radiotherapy Combined with Chemotherapy for Recurrent Rectal Cancer

目的：探讨三维适形放疗结合化疗治疗直肠癌术后复发的疗效。方法：57例术后复发直肠癌随机分为适形放疗组28例，常规放疗组29例。两组均先采用10MV-X线全盆腔常规放疗至44Gy；常规组后采用两后斜野成角照射推量至62～66Gy，适形组后改作三维适形放射治疗推量至66—70Gy。两组均于放疗第1周开始行全身化疗：甲酰四氢叶酸钙（CF）100mg、5-氟尿嘧啶（5-Fu）500mg／m^2第1—5d静滴，奥沙利铂130mg／m^2第1天静滴，21d 1个周期。结果：适形组和常规组1、2、3、4年生存率分别为82．1％、57．1％、39．3％、25．0％和75．9％,44．8％、27．6％、10．3％（P〈0．01），中位生存期分别为34和23月；4年肿瘤局部控制率分别为46．4％、20．7％（P〈0．05）。毒副反应两组差异无统计学意义（P〉0．05）。结论：三维适形放射治疗同步化疗是治疗直肠癌术后复发的有效方法，能提高直肠癌术后局部复发患者的生存率。

Objective To evaluate the efficacy of 3-dimensional conformal radiotherapy（3D-CRT） combined with chemothera- py for recurrent rectal cancer. Methods Fifty-seven patients with recurrent rectal cancer were randomly divided into 3-dimensional conformal radiotherapy group （ 3D-CRT group, 28 cases） and conventional radiotherapy group （ conventional group ,29 cases）. All patients were recieved a total 44 Gy conventional radiotherapy to the whole pelvic with 10MVX firstly, and then two oblique field radiation with dose of 62 - 66 Gy was given in conventional group ,3-dimensional conformal radio- therapy with dose of 66 -70 Gy was given in 3D-CRT group. Concurrent chemotherapy were given from the first week of radiotherapy and the chemotherapy regimen was as follows ：leucovorin （CF） 100 mg and 5-fluorouracil （5-Fu）500 mg/m^2 were given by intravenous dripping from d 1 to d 5, oxaliplatin （L-OHP）130 mg/m^2 were given by intravenous dripping on d 1, 21 days was one cycle. Results The 1,2,3,4 years survival rates of 3D-CRT group and conventional group were 82.1%, 57.1% ,39.3% ,25.0% and 75.9% ,44.8% ,27.6%, 10.3%, respectively （ P 〈 0.01 ）, the median survival time were 35 and 22 months, respectively. The 4 years local control rate of two groups were 46.4% ,20.7% （ P 〈 0.05 ）, respectively. The adverse reaction had no significant difference between the two groups（ P 〉 0.05 ）. Conclusion Three-dimensional conformal radiotherapy combined with chemotherapy may be an effective approach for recurrent rectal cancer and could improve the survival rate of recurrent patients.