消化道肿瘤腹腔淋巴结转移3D-CRT治疗的临床观察

Clinical observation of 3D-CRT in treatment of abdominal lymph node metastases of gastrointestinal cancer

目的:观察三维适形放射治疗(3D-CRT)消化道肿瘤腹腔淋巴结转移病灶的疗效及放射反应。方法:回顾性分析3D-CRT治疗消化道肿瘤腹腔淋巴结转移31例,常规分割,总剂量50～60 Gy。13例放疗同步口服卡培他滨化疗,剂量按体表面积计算825 mg/(m2.次),2次/d,d1～d14、d22～d35。近期疗效按RECIST实体肿瘤疗效标准评价,正常组织的放射反应按RTOG标准评价。结果:患者症状改善率达92.3%～100.0%。近期总有效率(CR+PR)为80.7%(25/31)。近期疗效与病灶体积、同步口服卡培他滨相关,P值分别为0.022、0.028;放射治疗剂量增加近期疗效有增加趋势,P=0.059;与病理类型无关,P=0.633。1、2和3年总生存率分别为53.2%、21.3%和3.6%,与放射治疗剂量及同步口服卡培他滨无关,P值分别为0.736、0.754。死亡28例,原因为其他部位多发转移占89.3%(25/28)。Ⅰ和Ⅱ级WBC减少和消化道反应发生率为41.9%(13/31)和71.0%(22/31)。增加放疗剂量与同步口服卡培他滨副反应未见明显增加,P值分为1.000、1.000、0.727和0.237。结论:3D-CRT治疗消化道肿瘤腹腔淋巴结转移病灶有较好的近期疗效,放疗反应较轻,患者耐受性好。同步口服卡培他滨可进一步提高近期疗效,放疗反应未见明显增加。

OBJECTIVE： To evaluate the therapeutic efficacy and radiation complication of three-dimensional conformal radiotherapy（3D-CRT） in the patients with abdominal lymph node metastases of gastrointestinal cancer.METHODS： Retrospective analysis of 31 patients with abdominal lymph node metastases of gastrointestinal cancer were treated with 3D-CRT with a total dose of 50-66 Gy.Totally 13 patients who received concurrent capecitabine（825 mg/m2 per fraction,bid,d1-d14,d22-d35）.Recent Clinical efficacy according to RECIST standards for evaluation of solid tumors,normal tissue radiation response evaluation according to RTOG criteria.RESULTS：Symptom improvement rate was 92.3%-100.0%.The total response（CR＋PR） rate was 80.7%（25/31）.The early response was related with the target volume.The smaller the better（P=0.022）.The concurrent capecitabine cases had better results（P=0.028）.There was an increasing trend of radiation dose increases（P=0.059）.There was no significant difference between the squamous carcinomas and adenocarcinomas in the early response（P=0.633）.1,2 and 3-year survival rates were 53.2%,21.3% and 3.6% respectively.There was no significant difference between the survival rates and radiant dosis or concurrent capecitabine（P were 0.736 and 0.754）.Twenty-eight patients died.The deaths reason of the other widespread metastasis was 89.3%（25/28）.The incidence of WBC fall and alimentary canal side effects in Grade Ⅰ and Ⅱwere 41.9%（13/31）,71.0%（22/31）,respectively.There was no significant difference between the patients who received the higer radiant dosis or concurrent capecitabine（P were 1.000,1.000,0.727 and 0.237）.CONCLUSIONS：3D-CRT can be considered as an effective and feasible approach for the treatment of metastatic abdominal lymph nodes,and no serious complications are observed.The concurrent capecitabine cases had the better early response,have no increased side effects.