中低位局部晚期直肠癌术前同步放化疗不同分割方式的临床研究

Different Fractionation Schedules of Radiotherapy in Preoperative Concurrent Chemoradiotherapy for Middle-low Locally Advanced Rectal Cancer

目的:评价中低位直肠癌术前改良短程放化疗与经典常规放化疗的近期临床疗效及远期生存。方法:中低位局部晚期直肠癌分为改良短程放化疗组(改良组)35例,经典常规放化疗组(常规组)37例。改良组放疗剂量30Gy,3Gy/次,5次/周,共10次,同步口服希罗达850mg/m^2,一天两次,第1~14天,休息2~3周手术;常规组放疗剂量45 Gy,1.8 Gy/次,5次/周,共25次,同步口服希罗达850mg/m^2,一天两次,第1~14天和第22~35天,休息4~6周手术。结果:改良组和常规组总有效率分别为83.6%、86.5%;T降期率分别为74.3%、70.3%;N降期率分别为42.9%、40.5%;保肛率分别为77.1%、75.7%,差异均无统计学意义(P>0.05)。改良组和常规组局部复发率分别为8.6%、10.8%;远处转移率分别为22.9%、27.0%;死亡率分别为17.1%;18.9%,但差异无统计学意义(P>0.05)。改良组患者3年总生存率为82.9%、平均生存时间为34.1±0.76月,常规组3年总生存率为81.1%,平均生存时间为34.7±0.6月,差异无统计学意义(P>0.05)。结论:术前改良短程放化疗和经典常规放化疗均可作为中低位局部晚期直肠癌新辅助治疗方案,且改良短程放化疗有治疗周期短、患者依从性高等优势。

Objective：To investigate the efficacy and safety between the improved short preoperative and the classic conventional preoperative chemoradiation in middle-low locally advanced rectal cancercases.Methods：Patients with middle-low locally advanced rectal cancers were classified into two groups,including the improved short preoperative chemoradiation 35 cases,and the classic conventional preoperative chemoradiation 37 cases.The dose in the improved-term group was 30 Gy/10 f/2 weeks,followed with Capecitabine 850 mg/m^2,two times one day,d1-14,aftercompletion of radiotherapy,the patients had rested 2-3 weeks and received the operation.The dose in the conventional-term group was 45 Gy/25 f/5 weeks radiation,with Capecitabine 850 mg/m^2,two times one day,d1-14 and d22-35,aftercompletion of radiotherapy,the patients had rested 4-6 weeks and received operation.R esults：The improved-term group total effective rate,T stage reduction rate,N stage reduction rate,phincter-saving rate were83.6%,74.3%,42.9%,77.1%,respectively,these rates were different compared with conventional-term group,86.5%,70.3%,40.5%,75.7%,but no significant difference between two groups（ P〈0.05）.The 3-yearloeoregional recurrence rates 8.6%,3-yeardistant metastasis rates 22.9%,death rates 17.1% in improved-term group were lowercompared with conventional-term group,10.8%,27.0%,18.9%,but no significant difference between two groups（ P〈0.05）.The3-yearoverall survival rate in improved-term group 82.9% was highercompared with conventional-term group81.1%,but they were no significant difference between two groups（ P〈0.05）.Conclusion：Both improved-term and classic conventional-term preoperative chemoradiation can be used as the regimen of preoperative neoadjuvant chemoradiotherapy in patients with resectable rectal cancer,improved-term chemoradiotherapy has a short treatment cycle and easily accepted by patients.