三维适形放疗联合卡培他滨治疗局部晚期(不可手术)直肠癌

Three Dimensional-conformal Radiotherapy Combined with Capecitabine Chemotherapy for Locally Advanced (Unresectable) Rectal Cancer

目的观察三维适形放疗同期口服卡培他滨治疗局部晚期(不可手术)直肠癌患者的近期疗效及治疗的依从性。方法38例经病理证实的局部晚期(T4或局部-区域复发)的直肠癌患者接受了全盆腔三维适形放疗(3DCRT),DT46～50Gy/23～25F,后缩野至肿瘤区继续推量至DT64～66Gy/32～33F,同期接受卡培他滨(1650mg.m-2.d-1)治疗,分2次口服,第1～14天,每3周为1个周期,共服用2个周期。结果疗效评价:CR5例(13.2%),PR17例(44.7%),SD10例(26.3%),PD6例(15.8%),总有效率(CR+PR)57.9%;中位生存时间18.0个月,1年和2年总生存率分别为63.43%和18.78%。疼痛症状缓解率为100%;全身状况好转率52.8%。治疗相关的毒副反应以腹泻、中性粒细胞减少及手足综合征为主,其Ⅲ级反应的发生率分别为15.8%、15.8%和7.9%,均无Ⅲ级以上反应。结论3DCRT联合口服单药卡培他滨的同期放化疗方案是局部晚期(不可手术)直肠癌较好的治疗方法,其治疗的依从性高、毒副反应轻、近期疗效肯定、姑息性减症作用明显,值得临床推广应用。

Objective To evaluate the compliance 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（for 46~50Gy/5 weeks and was boosted to the tumor 16~18Gy/2 weeks,2Gy/fraction,5 days/week）in combination with capecitabine 1 650mg·m-2·d-1,day 1-14,every 3 weeks.Results The overall response rate was 57.9%,with CR 5（13.2%）,PR 17（44.7%）,SD 10（26.3%）,PD 6（15.8%）,median survival time,the 1-year overall survival rate and the 2-year overall survival rate were 18 months,64.43%,18.78%,respectively.The remission rate of pain and improvement rate of performance status were 100% and 52.8%.Treatment-related toxicity mainly showed at diarrhea、neutrocytopenia and hand-foot syndrome,the incidence of grade 3 toxicity were 15.8%,15.8%,7.9%,respectively.there were no grade 4 toxicity and treatment-related death.Conclusion Combination of three dimensional-conformal radiotherapy with capecitabine is active in advanced rectal cancer,It is a well-tolerated regimen.