局部进展期直肠癌术前3DCRT与VMAT同期化疗远期疗效比较

doi:10.3760/cma.j.cn113030-20200313-00106

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摘要目的比较术前三维适形放疗(3DCRT)与容积调强弧形治疗(VMAT)同期化疗用于局部进展期直肠癌(LARC)的5年总生存(OS)及无进展生存(DFS)结果,并分析该新辅助模式下的诱导/巩固化疗的价值。方法回顾收集2007—2013年间在中山大学肿瘤防治中心接受术前3DCRT或VMAT同期联合化疗(主要为Xelox方案:卡培他滨加奥沙利铂)及手术的334例LARCs资料,其中3DCRT组172例,VMAT组162例。VMAT组靶区处方剂量为计划靶区1(PTV1)50 Gy分25次,PTV2 46 Gy分25次;3DCRT组处方剂量为PTV2 46 Gy分23次。全组中185例接受术前同期放化疗(即单纯同期放化疗组),149例在术前同期放化疗前、后接受了1~7个疗程(中位数2个疗程)的诱导/巩固化疗(即同期放化疗±诱导化疗±巩固化疗组,主要化疗方案为XELOX)。比较3DCRT组与VMAT组的5年OS及DFS差异,并分析同期放化疗±诱导化疗±巩固化疗组与单纯同期放化疗组放化疗期间急性不良反应、术后并发症、病理完全缓解(ypCR)率及生存的差异。结果全组中位随访时间为62.3个月(2.4~119个月),3DCRT组与VMAT组5年OS和DFS均相近,分别为79.0%与83.2%(P=0.442)和77.0%与82.1%(P=0.231)。同期放化疗组与同期放化疗±诱导化疗±巩固化疗组≥3级急性血液学不良反应及非血液学不良反应相近(7.0%与12.1%,P=0.114及14.1%与16.8%,P=0.491);术后并发症相近(17.3%与17.4%,P=0.971);ypCR率相近(25.4%与30.2%,P=0.329);5年OS相近(80.5%与82.0%,P=0.409)及DFS相近(78.0%与81.0%,P=0.252)。结论与术前3DCRT技术相比,VMAT技术并不显著改善患者5年OS及DFS,即使针对瘤床额外推量。在术前同期放化疗中加入中位2个疗程的诱导/巩固化疗并不显著提高ypCR率与生存,但不良反应可耐受。

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	肖林
	邓文静
	魏嘉旺
	肖巍巍
	王俏镟
	曾智帆
	刘孟忠
	高远红

关键词 ：局部进展期直肠癌/三维适形放射疗法, 局部进展期直肠癌/容积调强弧形疗法, 局部进展期直肠癌/化学疗法, 预后, 不良反应

Abstract：Objective To compare 5-year overall survival (OS) and disease free survival (DFS) between preoperative three dimensional conformal radiotherapy (3DCRT) and volumetric medulated arc therapy (VMAT) concurrently combined with chemotherapy for locally advanced rectum cancer (LARC), and analyze the value of induction and/or consolidation chemotherapy in these circumstances. Methods 334 patients with LARC treated with preoperative 3DCRT (172 cases) and VMAT (162 cases) concurrently combined with chemotherapy, main protocol XELOX (capecitabine plus oxaplatin), and subsequent surgery in Sun Yat-sen University from May 2007 to April 2013 were retrospectively analyzed. The radiation prescription dose for VMAT group was 50Gy 25 fractions for planning target volume1(PTV1), and 46Gy 25 fractions for PTV2. The radiation prescription dose for 3DCRT group was 46Gy 23 fractions for PTV2. One hundred and eighty-five cases of all received preoperative concurrent chemoradiotherapy (namely, CCRT group), 149 cases received preoperative concurrent chemoradiotherapy plus median 2 courses (1-7 courses) induction and/or consolidation chemotherapy (namely, CCRT±induction chemotherapy±consolidation chemotherapy group), whose main chemotherapy protocol was XELOX. Difference of 5-year OS and DFS between 3DCRT and VMAT group was compared. The rate differences of acute toxicity during chemoradiotherapy, postoperative complications, ypCR, and survival between CCRT group and CCRT±induction chemotherapy±consolidation chemotherapy group were analyzed. Results After a median follow-up of 62.3 months (2.4-119months) for the 334 patients, no any significant difference for 5-year OS (79.0% vs. 83.2%, P=0.442) and 5-year DFS (77.0% vs. 82.1%, P=0.231) between 3DCRT and VMAT group was observed. There was no any significant difference for the Grade 3hematological toxicity (7.0% vs. 12.1%,P=0.114) and non-hematological toxicity (14.1% vs. 16.8%,P=0.491) during chemoradiotherapy, postoperative complications (17.3% vs. 17.4%,P=0.971), ypCR rate (25.4% vs. 30.2%,P=0.329), 5-year OS (80.5% vs. 82.0%,P=0.714) and 5-year DFS (78.8% vs. 81%,P=0.479) between CCRT group and CCRT±induction chemotherapy±consolidation chemotherapy group. Conclusions Compared with 3DCRT, the physics advantage of VMAT technique does not significantly convert into clinical benefits and improve 5-year OS and DFS, even further boosting radiation dose to the gross tumor volume. It is safe for median 2 courses of induction and/or consolidation chemotherapy before and or after preoperative concurrent chemoradiotherapy in the treatment of LARC, though it does not significantly improve ypCR rate and survival.

Key words： Locally advanced rectum cancer/three-dimensional conformal radiotherapy Locally advanced rectum cancer/volumetric modulated arc therapy Locally advanced rectum cancer/chemotherapy Prognosis Adverse reaction

收稿日期: 2020-03-13

通讯作者: 高远红,Email:gaoyh@sysucc.org.cn

引用本文:

肖林,邓文静,魏嘉旺等. 局部进展期直肠癌术前3DCRT与VMAT同期化疗远期疗效比较[J]. 中华放射肿瘤学杂志, 2021, 30(2): 127-133.

Xiao Lin,Deng Wenjing,Wei Jiawang et al. Preoperative three dimensional conformal radiotherapy and volumetric modulated arc therapy concurrently combined with chemotherapy for locally advanced rectum cancer:a five-year follow-up study[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 127-133.

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