三维适形放疗联合替吉奥治疗42例局部复发直肠癌的临床观察

Three Dimensional-conformal Radiotherapy Combined with Tegafur chemotherapy for recurrent rectal cancer

目的观察三维适形放疗联合替吉奥治疗局部复发直肠癌患者的近期疗效及治疗的安全性。方法 42例经病理证实的局部复发的直肠癌患者接受了全盆腔三维适形放疗(3-DCRT),DT46～50Gy/23～25F,后缩野至肿瘤区继续推量至DT64～66Gy/32～33F,同期接受替吉奥口服化疗,(40～60)mg/(m2.d),2次/d,连服3周,休1周,共2周期。结果疗效评价:CR4例(9.5%),PR30例(59.5%),SD7例(16.6%),PD0例(0%),总有效率(CR+PR)69%;疼痛症状缓解率为100%;全身况好转率76.2%。主要毒副反应为中性粒细胞减少、消化道反应、及末梢神经毒性,以Ⅰ～Ⅱ度为主,Ⅲ～Ⅳ度少见,全组中性粒细胞减少发生率为66.7%,恶心呕吐发生率为45.2%,腹泻发生率为28.6%,末梢神经毒性发生率为26.2%。结论 3-DCRT联合替吉奥方案的同期放化疗方案是局部复发直肠癌较好的治疗方法,其近期疗效确切、治疗的依从性高、毒副反应可耐受,值得临床应用。

Objective To evaluate the compliance and efficacy of Radiotherapy combined with Tegafur for recurrent rectal cancer.Methods Thirty two patients with recurrent rectal cancer received three dimensional-conformal radiotherapy（for 46～50 Gy/5 weeks and was boosted to the tumor 16～18 Gy/2 weeks,2 Gy/fraction,5 days/week） in combination with FOLFOX,every 3 weeks.Results The overall response rate was 69%,with CR 4（9.5%）,PR 25（59.5%）,SD 7（16.7%）,PD 0（0%）.The remission rate of pain and improvement rate of performance status were 100% and 72.6%.Treatment-related toxicity mainly showed at neutrocytopenia 、gastrointestinal reaction and peripheral neurotoxicity,main to Ⅰ～Ⅱ degree,the grade Ⅲ or IV rare.The whole group of neutropenia occurred at a rate of 66.7%,nausea and vomiting occurred at a rate of 45.2%,diarrhea incidence was 28.6%,peripheral neurotoxicity occurred at a rate of 26.2%.Conclusion Combination of three Dimensional-conformal radiotherapy with the improved scheme of tegafur is active in recurrent rectal cancer,It is worthy of clinical application.