术前短程放疗与长程放化疗对局部进展期直肠癌患者长期生活质量的影响

Effects of Preoperative Short-course Radiotherapy and Long-course Radiochemotherapy on Long-term Quality of Life in Patients with Locally Advanced Rectal Cancer

目的探讨术前短程放疗与长程放化疗对局部进展期直肠癌(LARC)患者长期生活质量的影响。方法纳入经术前新辅助放疗或放化疗且术后随访3年以上处于无病生存状态的LARC患者55例,根据术前新辅助治疗的方式,分为短程放疗组(n=20)和长程放化疗组(n=35)。短程放疗组术前采用短程快速大分割放疗,总放射剂量25. 0Gy,剂量分割5. 0 Gy×5次;长程放化疗组术前采用常规分割放疗,总放射剂量45. 0～50. 4 Gy,剂量分割1. 8～2. 0 Gy×23～28次,同步化疗采用5-Fu或希罗达为基础的方案。采用生活质量核心评定量表(QLQ-C30)评估术后长期生活质量状态。结果短程放疗组和长程放化疗组在QLQ-C30量表总体健康评分(74. 8±15. 2 vs 76. 5±17. 6),躯体(82. 6±16. 7 vs 83. 9±14. 0)、角色(75. 3±16. 5 vs 77. 8±15. 9)、情绪(78. 6±18. 5 vs 80. 2±19. 1)、认知(80. 6±17. 5 vs 83. 4±16. 9)和社会功能(76. 8±16. 4 vs 78. 1±16. 6) 5个领域评分,疲劳(23. 5±7. 4 vs 25. 6±8. 0)、恶心呕吐(2. 8±1. 8 vs4. 2±2. 9)、疼痛(12. 8±10. 2 vs 11. 7±9. 5)、气促(15. 6±11. 3 vs 16. 3±10. 9)、失眠(20. 5±12. 6 vs 21. 7±12. 5)、食欲减退(6. 8±4. 9 vs 8. 5±5. 8)、便秘(10. 5±5. 9 vs 8. 2±4. 3)、腹泻(13. 2±6. 1 vs 10. 7±7. 2)和经济困难(10. 6±6. 9 vs13. 8±7. 5) 9个症状评分方面,差异均无统计学意义(P均> 0. 05)。结论术前短程放疗和长程放化疗对LARC患者长期生活质量的影响可能并无明显差别。

Objective To investigate the effect of preoperative short-course radiotherapy（SC-RT） and long-course radiochemotherapy（LC-RCHT） on the long-term quality of life in locally advanced rectal cancer（LARC） patients. Methods 55 patients with LARC treated with neoadjuvant radiotherapy or radiochemotherapy,who had disease-free survival in the follow-up for more than 3 years,were enrolled in this study.According to the form of neoadjuvant radiotherapy,the patients were divided into SC-RT group（ n =20） and LC-RCHT group（ n =35）.SC-RT group were treated with neoadjuvant radiotherapy with a total radiation dose 25.0 Gy（5.0 Gy×5）.LC-RCHT group were given neoadjuvant radiochemotherapy with a total radiation dose of 45～50.4 Gy（1.8～2.0 Gy×23～28） concomitant with 5-FU or capecitabine based chemotherapy.The QLQ-C30 was used to assess the long-term quality of life in both groups. Results No differences were observed in QLQ-C30 scale score between SC-RT and LC-RCHT group（ P〉0.05）,including the global health status（74.8±15.2 vs 76.5±17.6）,the 5 functional scales of physical functioning（82.6±16.7 vs 83.9±14.0）,role functioning（75.3±16.5 vs 77.8±15.9）,emotional functioning（78.6±18.5 vs 80.2±19.1）,cognitive functioning（80.6±17.5 vs 83.4±16.9）,and social functioning（76.8±16.4 vs 78.1±16.6）,and the 9 symptom items of fatigue（23.5±7.4 vs 25.6±8.0）,nausea and vomiting（2.8±1.8 vs 4.2±2.9）,pain symptoms（12.8±10.2 vs 11.7±9.5）,dyspnoea（15.6±11.3 vs 16.3±10.9）,insomnia（20.5±12.6 vs 21.7±12.5）,appetite loss（6.8±4.9 vs 8.5±5.8）,constipation（10.5±5.9 vs 8.2±4.3）,diarrhea（13.2±6.1 vs 10.7±7.2）,and financial difficulties（10.6±6.9 vs 13.8±7.5）. Conclusion There is no significant difference in the effect of preoperative short-course radiotherapy and preoperative long-course radiochemotherapy on long-term quality of life in patients with LARC.