局部进展期低位直肠癌新辅助放化疗初步临床观察

doi:10.3760/cma.j.cn113030-20191128-00493

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摘要目的探讨局部进展期低位直肠癌新辅助放化疗疗效。方法回顾分析2014-2018年间入组的46例局部进展期低位直肠癌患者,肿瘤下缘距肛缘6cm内。术前放疗采用SIB-IMRT技术,直肠肿瘤及阳性淋巴结照射58.75Gy分25次(2.35 Gy/次),盆腔淋巴引流区照射50Gy分25次(2.0 Gy/次),同步口服卡培他滨进行化疗。放化疗结束后间隔6~12周行直肠癌根治术。Kaplan-Meier法计算总生存(OS)、无瘤生存(DFS)、无进展生存(PFS),无局部复发生存(LRFS)、无转移生存(MFS)。单因素分析用log-rank法检验,多因素分析用Cox回归模型。结果中位随访时间为47个月,局部复发3例,远处转移6例,ypCR率为26%(12/46),保肛手术率为74%(34/46),R0切除率为100%(44/44),TN总降期率为87%(40/46),术后并发症发生率为13%(6/46)。3年OS、DFS、PFS分别为93%、91%、87%。单因素分析显示ypN分期是影响OS、DFS、PFS、LRFS、MFS的重要因素(均P<0.05),多因素分析显示ypN分期与DFS、PFS、LRFS、MFS均显著相关(均P<0.05)。结论局部进展期低位直肠癌患者行术前SIB-IMRT 58.75 Gy分25次联合卡培他滨化疗方案安全可行,提高了ypCR率及生活质量,不良反应可耐受,长期生存是否获益有待进一步深入研究。

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	刘璐
	冯林春
	刘其腾
	贾宝庆
	杜晓辉
	戴广海
	陈静
	戴相昆
	杨涛

关键词 ：直肠肿瘤/新辅助放化疗法, 放射疗法,同期加量调强, 化学疗法,卡培他滨

Abstract：Objective To evaluate the efficacy of preoperative neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer. Methods Clinical data of 46 patients with low rectal tumors located within 6 cm from the edge of anal admitted to our hospital between February 2014 and December 2018 were retrospectively analyzed. SIB-IMRT technique was adopted for preoperative radiotherapy. Rectal tumors and positive lymph nodes were irradiated with a dose of 58.75 Gy in 25 fractions (2.35 Gy/fraction), and pelvic lymphatic drainage area was given with 50 Gy in 25 fractions (2.0 Gy/fraction). Oral administration of capecitabine was delivered for concurrent chemotherapy. Radical surgery for rectal cancer was performed at 6 to 12 weeks after the end of chemoradiotherapy. The overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local recurrence-free survival (LRFS) and metastasis-free survival (MFS) were calculated by using Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox’s regression model. Results After a median follow-up of 47 months, local recurrence occurred in 3 patients and distant metastasis in 6 patients. The ypCR rate was 26%(12/46), the sphincter-preservation rate was 74%(34/46), the R0 resection rate was 100%(44/44), the overall tumor response TN down staging rate was 87%(40/46), and the postoperative complication rate was 13%(6/46). The 3-year OS, DFS, and PFS were 93%,91% and 87%, respectively. In univariate analysis, ypN staging was an important factor affecting OS, DFS, PFS, LRFS and MFS (all P<0.05). In multivariate analysis, ypN staging was significantly correlated with DFS, PFS, LRFS and MFS (all P<0.05). Conclusions Preoperative SIB-IMRT 58.75 Gy in 25 fractions combined with capecitabine chemotherapy is a safe and efficacious treatment for patients with low and locally advanced rectal cancer, which improves the ypCR rate and quality of life, and yields tolerable adverse reactions. Nevertheless, the long-term survival benefits remain to be validated.

Key words： Rectal neoplasm/neoadjuvant chemoradiotherapy Radiotherapy, simultaneous integrated boost intensity-modulated Chemotherapy, capecitabine

收稿日期: 2019-11-28

基金资助:科技部国家重点研发计划项目(2016YFC0105700)

通讯作者: 冯林春,Email:301flc@163.com

引用本文:

刘璐,冯林春,刘其腾等. 局部进展期低位直肠癌新辅助放化疗初步临床观察[J]. 中华放射肿瘤学杂志, 2020, 29(11): 954-958.

Liu Lu,Feng Linchun,Liu Qiteng et al. Preliminary clinical observation of neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(11): 954-958.

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