局部进展期非手术直肠癌外照射联合近距离治疗结果初步观察

Preliminary observation of the results of external irradiation combined with brachytherapy for inoperable locally advanced rectal cancer

目的探讨外照射联合近距离放疗在治疗局部进展期非手术直肠癌患者的疗效和不良反应。方法回顾分析2013-2015年间局部进展期非手术直肠癌患者11例临床资料,其中男7例、女4例。患者均接受盆腔外照射联合三维腔内近距离放疗,完成盆腔外照射放疗(DT50Gy分25次)后,行近距离推量DT15~20Gy分3~4次。盆腔转移淋巴结采用外照射推量至60~66Gy分30~33次。外照射期间均行同期卡培他滨单药化疗。放疗后采用RECIST标准进行疗效评价。应用Kaplan-Meier法计算生存和局控率。采用RTOG损伤分级标准评估早、晚期放疗反应。结果11例患者高剂量率三维腔内近距离治疗近距离中CTV D90%的EQD2 Gy为(21.3±1.60)Gy。原发灶完全缓解率为64%,部分缓解率为27%,客观缓解率为91%。中位随访时间36个月,1、2、3年总生存率分别为82%、64%、46%,无瘤生存率为64%、45%、27%;3年局部额控制率为46%。1例患者治疗结束后第8个月肺部转移。1-2级肠道急性不良反应7例,泌尿系统急性不良反应5例;2级骨髓抑制反应1例;1-2级肠道晚期不良反应5例,泌尿系统晚期不良反应1例;均给予对症处理后好转。结论外照射联合三维腔内近距离治疗在局部进展期不可手术的直肠癌患者中,疗效可靠且不良反应可耐受,是一种可行的、安全有效的直肠癌根治性治疗方案。

Objective To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer.Methods Clinical data of 11 patients with inoperable locally advanced rectal cancer,7 male and 4 female,admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed.All patients received pelvic external irradiation(50 Gy in 25 fractions),followed by a three-dimensional intracavitary brachytherapy boost(15-20 Gy in 3-4 fractions,1 fraction/week).External beam radiotherapy was used to boost the dose to the perirectal lymph nodes(60-66 Gy in 30-33 fractions).All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy.Efficacy evaluation was performed using the RECIST standard.Survival and local control rates were calculated using the Kaplan-Meier method.Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria.Results The CTV D90%EQD2 Gy of HDR 3D-ICBT among 11 patients was(21.3±1.60)Gy.The complete response(CR)and partial response(PR)rates were 64%and 27%,respectively,yielding an objective response rate(CR+PR)of 91%.With a median follow-up time of 36 months,the 1-,2-,and 3-year overall survival rates were 82%,64%and 46%,respectively.The 1-,2-,3-year disease-free survival rates were 64%,45%and 27%,respectively.The 3-year local control rate was 46%.One patient presented with lung metastases after 8 months,7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions,only one patient had grade 2 myelosuppression;long-term grade 1-2 intestinal reactions occurred in 5 patients,and 1 patient had long-term grade 1-2 bladder reaction.All the radiation-induced toxicities were alleviated by medication administration.Conclusions External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer,which yields reliable clinical efficacy and tolerable adverse reactions.