术后复发直肠癌同期放化疗与单纯放疗的随机临床研究

目的 探讨直肠癌术后复发同步放化疗的疗效与不良反应.方法 选择2005年1月至2010年1月收治的直肠癌术后复发患者65例,随机分为两组:放化组(A组)采用三维适形放疗同步FOLFOX方案化疗;单放组(B组)为单纯三维适形放射治疗.结果 A组与B组1、3、5年局部控制率分别为96.8%、81.4%、53.1%与90.8%、59.4%、20.7%,差异有统计学意义(P=0.017);1、3、5年生存率分别为90.6%、78.0%、50.9%与87.9%、58.4%、22.7%,差异有统计学意义(P=0.042);中位生存期分别为49个月与39个月.不良反应:A组胃肠道反应、骨髓抑制、神经毒性反应高于B组,差异有统计学意义(P<0.05),而皮肤损伤差异无统计学意义(P>0.05).结论 对术后复发直肠癌而言,同步放化疗的不良反应比单纯放疗严重,但均在耐受范围内,而局部控制率和远期生存期较单纯放疗获得提高,是一种有效、可行的治疗方法.

The randomized clinical study of concurrent chemoradiotherapy for the patients of postoperative recurrent rectal carcinoma

Objective To investigate the curative effect and adverse reaction of concurrent chemoradiotherapy for recurrent rectal carcinoma after operation.Methods From January 2005 to January 2010,65 patients of recurrent rectal carcinoma were randomly divided into two groups：patients in Group concurrent chemoradiotherapy（Group A）were treated with three-dimensional conformal radiotherapy with FOLFOX regimen chemotherapy;patients in Group radiotherapy alone（Group B）were treated with three-dimensional conformal radiotherapy simply.Results The local control rates of 1-,3-,5-years in Group A were 96.8%,81.4%,53.1%,and 90.8%,59.4%,20.7% in Group B respectively,the difference had statistical significance（χ2=5.737,P=0.017）.The survival rates of 1-,3-,5-years in Group A were 90.6%,78.0%,50.9%,and 87.9%,58.4%,22.7% in Group B respectively,the median survival time was 49 months and 39 months respectively.Toxicity：The incidences of gastrointestinal reactions,bone marrow suppression,neurotoxic responses in Group A were higher than Group B,the difference had statistical significance（P0.05）,the difference of the incidences of skin lesions had no statistical significance（P0.05）.Conclusions For the postoperative recurrent rectal carcinoma,the toxicity of concurrent chemoradiotherapy were higher than radiotherapy alone,but were in the tolerance range,but the local control rate and long term survival rate were improved,so concurrent chemoradiotherapy is an effective,feasible treatment method.