直肠癌术后VMAT同期化疗与IMRT同期化疗的急性不良反应比较

Comparison of the acute adverse reactions of same period chemotherapy of VMAT and IMRT after colorectal cancer surgery

目的比较直肠癌术后容积调强弧形治疗(VMAT)同期化疗与调强放射治疗(IMRT)同期化疗的急性不良反应,探讨VMAT同期化疗的临床应用价值。方法选取2010年7月~2017年1月于梅州市人民医院就诊的50例局部进展期直肠癌患者(T2~T4或N+)作为研究对象。根据不同的治疗方式,将其分为VMAT组(n=20例)和IMRT组(n=30例)。其中VMAT组患者采用VMAT联合卡培他滨同期化疗,IMRT组患者采用IMRT联合卡培他滨同期化疗,两组同期化疗方案均为卡培他滨825 mg/m2,2次/d,5次/周。辅助化疗为8~10次改良FOLFOX6方案。比较两组患者治疗期间皮肤黏膜、消化道、泌尿系及血液系统等急性不良反应的发生情况。结果 VMAT组患者均完成放疗,IMRT组有3例患者因不能耐受不良反应终止放疗。两组患者中急性不良反应最常见的依次是下消化道反应、皮肤黏膜反应及上消化道反应;IMRT组Ⅱ~Ⅳ级下消化道发生率显著高于VMAT组(P<0.05);两组皮肤黏膜反应、泌尿系反应、上消化道反应及白细胞减少、血小板下降、贫血等骨髓抑制反应比较,差异无统计学意义(P>0.05)。结论直肠癌术后VMAT联合卡培他滨同期化疗急性不良反应发生率较低,与IMRT联合卡培他滨同期化疗相比能显著减少严重的下消化道反应,治疗耐受性好。

Objective To compare the acute adverse reactions of same period chemotherapy of VMAT and IMRT after colorectal cancer surgery, and to explore the clinica/ application value of the same period VMAT chemotherapy.Meth- ods 50 patients with locally advanced rectal cancer （stage T2-T4 or N＋） from July 2010 to January 2017 in Meizhou People＇s Hospital were selected as the research object,according to the different ways of treatment,they were divided into VMAT group （n=20） and IMRT group （n=30）.Patients of the VMAT group were given the treatment of VMAT com- bined with Capecitabine at the same period,patients of the IMRT group were given the treatment of IMRT combined with Capecitabine at the same period.The same chemotherapy regimens of Capecitabine was 825 mg/m^2,2 times per day, 5 times per week.Adjuvant chemotherapy for 8-10 times of improved FOLFOX6 scheme.Acute adverse reactions of pa- tients of two groups during treatment,such as skin mucous membrane,digestive tract,urinary tract and hematologic sys- tem were compared.Results All patients of the VMAT group completed the operation,and 3 cases of the IMRT group could not tolerate the adverse reactions and terminated the radiation.The most common adverse reactions of patients in the two groups were digestive tract,upper gastrointestinal tract,skin and mucosa reaction and response in sequence;the incidence of levels II-IV digestive tract in the IMRT group was significantly higher than that of VMAT group （P〈0.05）. In the two groups in the reaction of skin mucous membrane,urinary system,upper gastrointestinal tract,and bone marrow suppression such as leukopenia,decreased platelet and anemia had no significant difference （P〉0.05）.Conclusion Post- operative rectal cancer same period chemotherapy of VMAT combined with Capecitabine has a lower incidence of acute adverse reactions,compared with IMRT combined with Capecitabine can significantly reduce the severe gastrointestinal reaction,and with good tolerance.