同期放化疗治疗局部晚期不可手术的直肠癌近期疗效观察

Effect of chemoradiotherapy for locally advanced unresectable rectal cancer

目的:观察同期放化疗治疗局部晚期不可手术的直肠癌患者的近期疗效及耐受性。方法:38例经病理证实的局部晚期或局部-区域复发的直肠癌患者接受全盆腔三维适形放疗DT46～50Gy/23～25f,后缩野至肿瘤区继续推量至DT64～66Gy/32～33f,同期接受奥沙利铂130mg/m2d1,氟尿嘧啶350mg/m2d1～d5,甲酰四氢叶酸200mg/m2d1～d5,4周为1周期,共2个周期。结果:获CR7例(19.4%),PR16例(44.4%),SD6例(16.7%),PD7例(19.4%),总有效率(CR+PR)为63.9%;疼痛症状缓解率为100%;全身状况好转率72.2%;中位生存时间为22个月,1年和2年总生存率分别为67.7%和21.3%。治疗相关的毒副反应以中性粒细胞减少、腹泻、恶心呕吐以及周围神经毒性反应为主,其3级毒副反应的发生率分别为19.4%、16.7%、13.9%和11.1%,均无3级以上毒副反应发生。结论:以奥沙利铂为基础的化疗同期联合放疗对局部晚期不可手术直肠癌患者具有较好的姑息治疗作用,其治疗依从性高,治疗相关毒性可以接受,值得临床进一步推广。

Objective：To evaluate the safety and efficacy of chemoradiotherapy for locally advanced unresectable rectal cancer. Methods：Thirty-eight patients with locally advanced （T4 or recurred） rectal cancer received three dimensional-conformal radiotherapy combined with oxaliplatin 130mg/m^2 day 1,5-FU 350mg/m^2 days 1-5 ,LV 200mg/m^2 days 1-5 every 4 weeks. Results：The overall response rate was 63.9% , CR19.4% , PR 44. 4%, SD 16. 7%, PD 19.4%, median survival time was 22 months, and the 4 -, 2-year overall survival rate were 67. 7% and 21.3%, respectively. Treatment-related toxicity included neutrocytopenia, diarrhea, nausea, vomiting and neurotoxicity. There were no treatment-related death and grade 4 toxicity. Conclusion ： Combination of three dimensional- eonformal radiotherapy with oxaliplatin and 5-FU/LV is active in advanced unresectable rectal cancer, and it is a well-tolerated regimen.