术前短程放疗联合化疗治疗直肠癌患者的初步经验

Preliminary experience of short-course radiotherapy followed by neoadjuvant chemotherapy for rectal cancer patients

目的初步探讨术前短程放疗联合化疗治疗直肠癌患者的近期疗效以及不良反应。方法选取2015年8月30日至2016年4月25日本院收治的69例Ⅱ/Ⅲ期中低位直肠腺癌初治患者。入组患者接受5Gy×5次短程放疗联合4周期新辅助化疗,之后进行根治性手术及辅助化疗。对新辅助治疗期间患者的不良反应和耐受性进行分析,并评估新辅助治疗后肿瘤的退缩情况。结果 69例患者均在1周时间内完成短程放疗,未出现放疗剂量降低和放疗中断,分别有5例和3例患者出现化疗剂量降低和化疗中断,新辅助治疗的足量完成率达88.4%。新辅助治疗期间3~4级不良反应的发生率为27.5%,未出现治疗相关死亡,总体有效率达92.8%。结论术前短程放疗联合化疗治疗直肠癌安全且有效。

Objective A phase III clinical study （STELLAR trial, NCT02533271） is on going about optimization ofpreoperative treatment, which is attempt to compare effectiveness of short course radiotherapy （SCRT） followed by neoadjuvant chemotherapy （NACT） with preoperative long-term chemoradiotherapy （CRT） in locally advanced rectal cancer （LARC）. Initially, we analyzed the acute toxicity and patient＇s tolerance to SCRT followed by NACT due to few experience knew about it. Method Previously untreated patients of stage II/III middle and lower（〈 10cm） rectal adenocarcinoma will receive a SCRT followed by NACTs. In total, 4 cycles of NACTs are prescribed preoperatively, followed by a TME surgery and postoperative adjuvant chemotherapy. Result Up to April 25, 2016, 69 patients, who have fmished neoadjuvant treatment, can be analyzed. Incidence of total and grade 3~4 acute toxicities were 100% and 27.5% during the whole preoperative treatment. As to the period of SCRT, end of SCRT to beginning of NACT and NACT, the incidences of grade 3-4 toxicity were 0, 20.3% and 10.1%, respectively. All patients finished SCRT with no treatment interruption.There were 6 patients forced to delay NACT and 5 with dose-reduction due to toxicities. After SCRT followed by NACT, the rate of （CR＋PR） reached 92.8%. Conclusion The acute toxicity and patient＇s tolerance in the treatment regimens of short course radiotherapy followed by neoadjuvant chemotherapy is acceptable and effective.