局部晚期直肠癌术前同期加量调强放疗与三维适形放疗的远期疗效比较

Comparison of long term effects between preoperative simultaneous integrated boost intensity-modulated radiation therapy and three dimensional conformal radiotherapy for locally advanced rectal cancer

目的评估局部晚期直肠癌术前同期加量调强放疗(SIB-IMRT)与三维适形放疗(3D-CRT)的远期疗效及晚期毒性反应。方法选取2010年5月至2015年5月在该院行新辅助放化疗的130例临床分期为T3~4/N^(+)M0初治低位直肠腺癌患者为研究对象,根据随机数表法分为SIB-IMRT组(66例)和3D-CRT组(64例)。SIB-IMRT组对直肠原发肿瘤及盆腔转移淋巴结照射55 Gy/25次,高危复发区域和区域淋巴引流区照射45 Gy/25次。3D-CRT组对高危复发区域和区域淋巴引流区照射45 Gy/25次。所有患者放疗第1~14天及第22~35天口服卡培他滨825 mg/m^(2)(每天2次)同步化疗。放化疗结束后6~8周行全直肠系膜切除术。观察并比较两组总生存(OS)率、无病生存(DFS)率、局部无复发生存(LRFS)率、远处转移率(DMR)及晚期毒性反应发生情况。结果所有研究对象中位随访时间为105(2,136)个月。SIB-IMRT组10年OS率、DFS率、LRFS率、DMR分别为67.8%、64.5%、91.8%、29.9%,3D-CRT组10年OS率、DFS率、LRFS率、DMR分别为62.6%、61.2%、88.7%、34.5%,差异无统计学意义(P>0.05)。SIB-IMRT组2、3级不良反应高于3D-CRT组(34.48%vs.28.07%),但差异无统计学意义(P>0.05)。结论SIB-IMRT较3D-CRT提供可接受的远期疗效与毒性结果。

Objective To compare the long-term effects and later period toxic reactions between preoperative simultaneous integrated boost intensity-modulated radiation therapy(SIB-IMRT)and 3-dimensional conformal radiotherapy RT(3D-CRT)for locally advanced rectal cancer.Methods A total of 130 patients with clinical stage cT3-4/N^(+)M0 rectal adenocarcinoma receiving neoadjuvant chemoradiotherapy in this hospital from May 2010 to May 2015 were selected as the study subjects.The patients were divided into the SIB-IMRT group(66 cases)and 3D-CRT group(64 cases)according to the random number table method.The SIB-IMRT group took the irradiation 55 Gy/25 frequencies,irradiation 45 Gy/25 frequencies in the high risk recurrent region and regional lymphatic drainage area.The 3-DCRT group took the irradiation 45 Gy/25 frequencies in the high risk recurrent region and regional lymphatic drainage area.All patients orally took capecitabine(825 mg/m 2)on 1-14 d and 22-35 d of radiotherapy(twice daily)in synchronized radiotherapy.The total mesorectal excision was performed in 6-8 weeks after radiotherapy end.The overall survival(OS)rate,disease free survival(DFS)rate,locoregional recurrence free survival(LRFS)rate,distant metastasis rate(DMR)and occurrence situation of advanced stage toxic reactions were observed and compared between the two groups.Results The median follow-up time of all study subjects was 105(2,136)months.The 10-year OS rate,DFS rate,LRFS rate and DMR in the SIB-IMRT group was 67.8%,64.5%,91.8%and 29.9%respectively,which in the 3D-CRT group was 62.6%,61.2%,88.7%and 34.5%respectively,but the differences were not statistically significant(P>0.05).The grade 2 and 3 adverse reactions in the SIB-IMRT group were higher than those in the 3D-CRT group(34.48%vs.28.07%),but the difference was not statistically significant(P>0.05).Conclusion SIB-IMRT provides the acceptable long term effect and toxic results than 3D-CRT.