局部晚期中低位直肠癌术前螺旋断层同期加量放疗并同步口服卡培他滨化疗的效果

Chemoradiation effect of combined preoperative intensity-modulated radiotherapy with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost of tomotherapy

目的 探讨螺旋断层同期加量放疗(SIB-IMRT)并同步口服卡培他滨化疗对局部晚期可手术切除的中低位直肠癌的安全性及有效性.方法 局部晚期中低位直肠癌患者16例,TNM分期为Ⅱ、Ⅲ期,螺旋断层同期给予两个剂量水平(55.0和47.5 Gy/25次)放疗,同步口服卡培他滨化疗(825mg/m2,2次/d,5d/周).放化疗结束后8～9周接受全直肠系膜切除术.观察毒副作用、保肛率、术后并发症及病理完全缓解(PCR)率.放化疗毒副作用分级按NCI-CTC3.0标准.结果 所有患者均顺利完成放化疗方案,螺旋断层放疗计划取得了优良的靶区覆盖、均匀性及适形度剂量分布.2例患者因新辅助治疗后原发肿瘤消退、症状完全缓解而拒绝手术.14例手术患者中11例(78.6％)行直肠低前位保肛术,4例(28.6％)患者术后达PCR.血液系统及胃肠道Ⅰ、Ⅱ度毒副作用发生率为62.5％ (10/16)、18.8％(3/16),皮肤Ⅲ度毒副作用发生率为62.5％(10/16),无Ⅳ度以上毒副作用发生.1例于术后第13天发生切口感染.结论 局部晚期中低位直肠癌术前螺旋断层同期加量放疗并同步口服卡培他滨化疗安全可行,并有望提高局部控制率,其长期疗效有待更大样本量及长期的随访来评估.

Objective To assess the safety and efficacy of preoperative intensity-modulated radiotherapy(IMRT) with oral capecitabine in patients with locally advanced mid-low rectal cancer using a simultaneous integrated boost (SIB) of tomotherapy.Methods Total 16 patients with resectable locally advanced mid-low rectal cancer (patients with T3 to T4 and/or N ± rectal cancer) were enroll in current study.Patients were received IMRT to 2 dose levels simultaneously (55 and 47.5 Gy in 25 fractions) with concurrent capecitabine 825 mg/m2 twice daily,5 days/week.Total mesorectal excision was performed at 8 to 9 week after the completion of chemoradiation.The primary end point included side effect,the rate of sphinctersparing,postoperative complication and pathological complete response rate (pCR) were observed.Side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0.Results All patients were received chemoradiotion therapy without any break.Tomotherapy showed superiority with respect to target coverage,homogeneity and conformality.Two patients refused to perform radical surgery because of almost complete primary tumor regression and complete symptom relief after neoadjuvant therapy.Fourteen patients underwent surgical resection and 11 patients (78.6％) underwent sphincter-sparing lower anterior resection.Four patients(28.6％) had a pathological complete response.The incidence of grade 1-2 hematologic,gastro-intestinal toxicities were 62.5％ (10/16) and 18.8％ (3/16).The incidence of grade 3 skin toxicities were 68.8％(10/16).Grade Ⅳ side effect was not observed.Surgical complications (incisional infection on thirteen after surgery) were observed in 1 patient.Conclusion Preoperative simultaneous integrated boost of tomotherapy with concurrent oral capecitabine is safe and well tolerated in patients with a promising local control.However,a larger number of patients and a long follow-up are required to assess its potential superiority.