15例直肠肛管癌放射治疗加化疗的疗效

Chemoradiotherapy for carcinoma of lower rectum and anal canal

目的 观察放射治疗加化疗低位直肠癌与肛管癌的疗效与副反应。方法 15例低位直肠癌与肛管癌中 4例有腹股沟淋巴结肿大者先行 1～ 3个疗程化疗 ,其余先行DT4 0～ 6 0Gy外照射治疗。近距离放射治疗包括腔内和肛周组织间插植治疗 (8～ 18Gy)。同时全身以氟尿嘧啶为主的静脉化疗 ,共 3～ 6个疗程。结果 平均随访 4 9.1个月 ,15例中 14例肛门全部获得保留 ,局部控制率为6 0 .0 % ,5年生存率为 6 6 .7%。主要急性并发症发生在消化道 ,腹泻发生占 12 / 15 ,国际抗癌联盟(UICC)的 2级以上腹泻占 5 / 12 ;2例经保留灌肠治疗缓解 ;1例因放射性直肠炎慢性便血 30个月 ;2例出现肛门失禁症状 ,其中 1例经外科切除肛门结肠造口。 9例出现UICC 2级以上骨髓抑制 ,4例经粒细胞集落刺激因子治疗缓解 ,其余 5例被迫中断化疗。结论 低位直肠肛管癌的全身化疗加放射治疗远期疗效较好 ,其疗效不比根治性手术差 ,能保留肛门提高患者生存质量。

Objective To evaluate the efficacy and toxicity of radio-chemotherapy as a primary treatment for the lower rectal and anal canal cancer.Methods From October 1995 to September 2002, 15 patients with lower rectal and anal canal cancer were treated by radio-chemotherapy.Site:lower rectal 5,anal canal 10 and unclear 4. 1-3 cycle chemotherapy were used before radiation in 4 patients with positive inguinal nodes while the others received external radiation of 40-60?Gy followed by brachytherapy including high dose rate 192 Ir perianal interstitial(PI) and intracavitary insertion (II)irradiation of 8-18?Gy. Four patients received II while 11 received PI+II.Concomitant chemotherapy was given for all patients with 3-6 cycles of 5-Fu based regimen.Results Anal sphincter function was preserved in 93%(14/15) patients with a median follow-up duration of 49.1 months. The 5-year local control rate was 60% (9/15) and survival rate was 66.7 % (Kaplan-Meier Method).The main acute complications occurred in the gastrointestinal tract, diarrhea was present in 12/15 with grade 2(UICC)in 5/12 and 2 of them were controlled by retention enema.Rectal bleeding caused by radiation proctocolitis continued for 30 months in one patient.Colostomy had to be resorted to in one of 2 patients with incontinence. Acute grade 2 leukopenia developed in 9/15 patients, in 5 of whom chemotherapy had to be discontinued and 4 were able to complete their chemotherapy with granulocyte stimulating factor(G-CSF) administration. There was no mortality caused by this treatment.Conclusions Concomitant radio-chemotherapy provides an alternative to definitive surgical treatment for epithelial carcinoma of the lower rectum and anal canal, not only giving good control but better quality of life also.