放射治疗联合奥沙利铂与卡培他滨治疗局部晚期直肠癌的疗效观察

Efficacy of the radiotherapy combined with oxaliplatin and capecitabine in the treatment of local advanced rectal cancer

目的:评价术前放射治疗联合奥沙利铂与卡培他滨的方法治疗局部晚期(T3-4)直肠癌的临床疗效和安全性。方法:54例局部晚期直肠癌患者接受术前盆腔放射治疗(50Gy/25次),同步接受奥沙利铂联合卡培他滨的化疗方案(奥沙利铂100mg/m2,静脉滴注第1天和第22天;卡培他滨825mg/m2,口服2次/d,第1～14天以及第22～35天)。结果:54例患者中有51例接受了手术治疗,其中10例(19.7%)患者获得了病理完全缓解(pathologic complete response,pCR),R0切除率为100%,保肛率为51.0%。1年和2年生存率分别为91.0%和83.8%。最常见的不良反应是血液学不良反应,3度以上的不良反应主要是贫血(1.9%)、白细胞减少(11.2%)和血小板减少(1.9%);最常见的非血液学不良反应是腹泻。结论:术前放射治疗联合卡培他滨与奥沙利铂的治疗方案对局部晚期直肠癌有一定的疗效,且不良反应率较低,是一种有效及较为安全的综合治疗方法。

Objective：To evaluate the efficacy and safety of preoperative radiotherapy （RT） combined with concurrent oxaliplatin and capecitabine chemotherapy in the treatment of local advanced rectal cancer at T3 to T4 stage.Methods：Fifty-four patients with T3-T4 local advanced rectal cancer received preoperative pelvic radiation （50 Gy in 25 fractions） and concurrent combined chemotherapy. Oxaliplatin was administered at 100 mg/m^2 on d 1 and 22 by intravenous infusion and capecitabine was administered orally at 825 mg/m^2 bid on d 1 to 14 and d 22 to 35.Results：Fifty-one patients out of 54 eligible patients received surgery. Among them 10 patients （19.7%） achieved pathologic complete response （pCR）. R0 resections were achieved in 100% of patients, and sphincter preservation was accomplished in 51.0% of the patients. The 1-year survival rate was 91.0%, and 2-year survival rate was 83.8%. The most common adverse reaction was hematologic toxicity. The grade 3 adverse reactions mainly included anemia （1.9%）, leucopenia （11.2%）and thrombocytopenia （1.9%）. The most common non-hematologic toxicity was diarrhea.Conclusion：Preoperative radiotherapy combined with concurrent capecitabine and oxaliplatin chemotherapy was an effective and safe therapeutic regimen for local advanced rectal cancer with low frequency of adverse reactions.