两种放化疗联合方法治疗局部晚期直肠癌的疗效比较

Clinical Study on the Treatment of Local Late Rectal Carcinoma by Combined Radiotherapy and Chemotherapy

为比较序贯放化疗及同步放化疗治疗局部晚期直肠癌的临床疗效和毒副反应，回顾分析大连大学附属新华医院采用序贯放化疗（22例，序贯放化组）及同步放化疗（24例，同步放化组）的46例局部晚期直肠癌患者资料，并对其疗效及毒副反应进行对比分析。序贯放化组采用化疗一放疗化疗交替治疗，共放化疗6周期；同步放化组放疗的第1、4周同时接受化疗2个周期，同步放化疗结束后，再接受4个周期化疗。结果显示，两组近期疗效差异无统计学意义（P〉0．05）。同步放化组（25．3个月）较序贯放化组（18．7个月）延长了中位无进展生存时间（PFS），且差异有统计学意义（P〈O．05）；两组中位总生存时间（OS，28．5个月和22．5个月），差异无统计学意义（P〉0．05）。序贯放化组和同步放化组1年无进展生存率分别为77．3％和95．8％，2年无进展生存率分别为31．8％和54．2％，1年总生存率分别为90．9％和100％，2年总生存率分别为40．9％和75．0％。疾病进展主要为远处转移。两组毒副反应主要为恶心、呕吐、WBC下降、腹泻及神经毒性，均较轻，未见Ⅳ级毒副反应，经对症治疗后均能耐受，从而顺利完成治疗。两组毒副反应发生率除腹泻差异有统计学意义（P〈O．05）外，其余均无统计学意义（P〉O．05）。结果表明，同步放化疗缩短了治疗周期，延长了PFS，提高了生存率，虽部分加重了毒副反应但均可耐受，具备临床应用价值。

The objective of the study was to assess and compare the therapeutic efficacy,toxic and adverse reaction of sequential radio-chemotherapy （SeRCT） and synchronous radio-chemotherapy （SyRCT） in the treatment of local late rectal carcinoma（LLRC）. The clinical data of 46 patients with LLRC in Xinhua hos- pital who had undergone SeRCT or SyRCT were analyzed comparatively. Patients in SeRCT group（ n =22） underwent chemotherapy-radiotherapy-chemotherapy alternatively for 6 cycles, while patients in the SyR- CT group（ n =24） underwent radiotherapy at the first and fourth week and chemotherapy simultaneously for 2 cycles,after SyRCT follwed by chemotherapy for 4 cycles. As results,there was no statistical signifi- cance in terms of short-term therapeutic efficacy between the two groups（ P 〉0.05）;the median progress- free survival（PFS） time in the SyRCT group and SeRCT group was 25.3 and 18.7 months respectively（ P 〈0.05） ;the median overall survival（PFS） time in the two groups was 28.5 vs 22.5 months（ P 〉0.05） ; the PFS rate for the first one year in the SeRCT and SyRCT groups was 77.3% vs 95.8% ,that for the first two years in the two groups was 31.8% vs 54.2% ,the general survival rate for the first one year in the two groups was 90.9% vs 100% and that for the first two years in the two groups was 40.9% vs 75.0%; distant metastasis was the main cause of progression; the toxic 8〉 adverse reaction included mild nausea, vomiting,reduction of WBC, diarrhea and neurotoxicity in the two groups（ P 〉0.05）,while there was statistial significance in diarrhea between the two groups（ P 〈0.05）. There was not 1V degree toxic adverse reaction,the patients could tolerate via symptomatic treatment,therefore complete the treatment suc- cessfully. It is concluded that the SyRCT is of value of clinical application in terms of shorter treatment cycle and higher survival rate, prolonged PFS.