局部晚期直肠癌新辅助调强放疗的临床研究

Clinical study of neoadjuvant intensity-modulated radiotherapy for locally advanced rectal cancer

目的探讨局部晚期直肠癌新辅助同期加量调强放疗的疗效及安全性。方法选取2015年2月至2016年12月在本院接受治疗的64例直肠癌患者进行研究,采用随机数表法将其分为调强放疗组和三维适行组,每组32例。观测2组患者的不良反应、手术相关指标以及术后病理降期。结果 2组不良反应的发生率差异无统计学意义(P>0.05)。调强放疗组与三维适行放疗组的手术时间、术中出血量、淋巴结清扫数、住院天数以及术后排气时间[分别为(168±48)min、(131±31)mL、(12.4±2.6)枚、(19±5)d、(2.6±1.0)d与(152±44)min、(143±34)mL、(12.0±3.2)枚、(18±5)d、(2.8±0.8)d]。差异均无统计学意义(P>0.05)。调强放疗组3级以上病理降期率为41%,显著高于三维适行组(25%)(P<0.05)。结论新辅助同期加量调强放疗对局部晚期直肠癌的疗效和安全性与三维适行放疗相当,病理降期率较高。

Objective To evaluate the efficacy and safety of neoadjuvant concurrent intensity-modulated radiotherapy for locally advanced rectal cancer.Methods Sixty four patients with rectal cancer were selected for the study.The patients were randomly divided into IMRT group and 3-DCRT group,and each group has 32 cases.The adverse reactions,operation related indexes and postoperative pathological descending period of the two groups were observed.Results The incidence of diarrhea in the IMRT group and the 3-DCRT group were 59%and 66%,respectively.There was no significant difference in the incidence of adverse reactions between the two groups（P〈0.05）.The operation time,intraoperative blood loss,the number of lymph node dissection, the number of days of hospitalization and postoperative exhaust time of the IMRT group and 3-DCRT group were（168±48）min,（131±31）mL,（12.4±2.6）,（19±5）d,（2.6±1.0）d and（152±44）min,（153±34）mL,（12.0±3.2）,（18±5）d,（2.8±0.8）drespectively.The difference was not significant（P〈0.05）.Pathological decline rate above grade 3 in the IMRT group was 41%,which was higher than that in the 3-DCRT group（25%）（P〈0.05）.Conclusion The efficacy and safety of neoadjuvant concurrent intensity modulated radiotherapy for locally advanced rectal cancer are similar to that of three-dimensional radiotherapy,and the rate of pathological reduction is higher.