局部复发性直肠癌再程外放疗研究进展

Progress in the re-irradiation for locally recurrent rectal cancer

随着外放疗(EBRT)的进步,包括调强放疗和立体定向放疗的普及和质子、重离子放疗技术的应用,既往接受过盆腔放疗的局部复发性直肠癌(LRRC)病人再程EBRT的不良反应明显减少,其疗效也逐渐得到肯定。对于可切除性LRRC,应考虑术前或术中给予再程EBRT提高R0切除率、降低局部复发率;如无法手术,可以考虑再程EBRT姑息治疗。虽然放疗范围、剂量目前没有统一建议,但考虑到后期毒性反应,再程EBRT宜采用超分割模式。

With the development of external beam radiotherapy(EBRT)including the promotion of intensity modulated radiation therapy and stereotactic body radiotherapy and the advent of proton therapy and heavy ion therapy,toxicity related to re-irradiation for locally recurrent rectal cancer(LRRC)who have previously received pelvic EBRT has decreased greatly,and the efficacy has been confirmed gradually.As for resectable LRRC,pre-or intraoperative EBRT can improve R0 rate and decrease local control rate;while as for unresectable LRRC,re-EBRT can relieve symptom.There is no consensus on the clinical tumor volume and dosage of re-irradiation for LRRC;however,we suggest hyperfractionated EBRT for LRRC in view of lateronset toxicity.