中低位直肠癌术前短程与长程同步放化疗的临床疗效比较

Comparison of clinically therapeutic efficacy of the improved short-term and classic long-term preoperative chemoradiation in the treatment of mid-low rectal cancers

目的 比较改良的术前短程同步放化疗与经典的术前长程同步放化疗对局部晚期中低位直肠癌的临床近期疗效和急性放射性毒性反应.方法 中低位局部晚期直肠癌按治疗方法分组,42例行改良的术前短程同步放化疗（短程组）,45例行经典的术前长程同步放化疗（长程组）.短程组剂量为30 ～ 39Gy/10～13 f/2～3周,配合5-Fu 225 mg/（m2·d）持续静脉泵入,休息3～4周行手术治疗.长程组靶区剂量45 ～50.4 Gy/25～28 f/5～6周,放疗的d1-4和d22-25配合5-Fu 400 mg/（m2·d）微电脑持续泵入,放疗完成后休息4～6周行手术.比较两组的临床近期疗效和急性放射性毒性反应.结果 短程组和长程组的总有效率（CR＋ PR）分别为88.09％和86.67％,肿瘤消退分级（TRG）4级分别为14.29％和17.78％,保肛率分别为69.05％和71.11％,T分期降期率分别为76.19％和73.33％,N分期降期率分别为52.38％和57.78％,差异均无统计学意义（P＞0.05）.两组术后肠梗阻、吻合口瘘和伤口愈合不良的发生率差异无统计学意义（P＞0.05）.短程组的急性放射性下消化道反应明显低于长程组（P＜0.05）,而皮肤反应、膀胱反应、骨髓抑制差异无统计学意义（P＞0.05）.结论 短程组和长程组的临床有效率、病理反应率和保肛率相似,没有增加术后的并发症;短程组的下消化道放疗反应低于长程组,值得临床推广.

Objective To compare clinical recent efficacy and acute radiation toxicity reaction of the improved short-term and classic long-term preoperative chemoradiation in the treatment of locally advanced middle-low rectal cancers.Methods Patients with middle-low locally advanced rectal cancers were randomly classified into two groups,including the improved preoperative short-term chemoradiation （short-term group; n =42）,and the classic preoperative long-term chemoradiation （long-term group; n =45）.The dose in the short-term group was 30 ～ 39 Gy/10 ～ 13 f/2 ～ 3 weeks,with 5-Fu 225 mg/（m2 · d） continuous intravenous pumping; after completion of radiotherapy,the patients rest 3 ～ 4 weeks and went operation.The dose in the Long-term group was 45 ～ 50.4 Gy/25 ～28 f/5 ～6 weeks,radiation of d1-4 and d22-25 with 5-Fu 400 mg/（m2 · d） continuous intravenous pumping; after completion of radiotherapy,the patients rest 4 to 6 weeks and went operation.The clinical effect and recent acute radiation toxicity reactions were compared between two groups.Results For the short-term and long-term groups,the total effective rate （CR ＋ PR） was 88.09% and 86.67%,respectively; TRG4 level was 14.29% and 17.78%,respectively; sphincter-saving rate was 69.05% and 71.11%,respectively; the T stage reduction rate was 76.19% and 73.33%,respectively; and N stage reduction rate was 52.38% and 57.78%,respectively; they were all no significant difference between two groups （P 〉 0.05）.The postoperative incidence rate of intestinal obstruction and anastomotic fistula and poor wound healing were no significant difference between two groups （P 〉 0.05）.The lower digestive tract response of acute radioactive in short-term group was significantly lower than long-term group （P 〈 0.05） ;while the skin reactions,bone marrow suppression and bladder reaction were no significant difference between two groups （P 〉 0.05）.Conclusions Clinical effectiveness,pathological response rate,and sphincter-saving rate were similar between short-term and long-term groups.Postoperative complications were not increased in the short-term group relative to the long-term group.The lower digestive reaction is lower in the short-range group than in the long-term group.Thus,the optimized short-term preoperative chemoradiation is worth clinically popularizing in the treatment of locally advanced middle-low rectal cancers.