三维适形放疗治疗直肠癌术后复发病例临床观察

目的：观察三维适形放疗治疗直肠癌术后复发病例的疗效。方法：选择直肠癌术后复发患者54例接受三维适形放疗,其中低分化腺癌4例,中分化腺癌37例,高分化腺癌7例,粘液腺癌6例。放疗总剂量在60－72GY／22－24F／每周4－5次,其毒性作用用血液学、生化试验、胃肠道和泌尿系统反应进行评价。观察有无放射性肠淡症状,监测血细胞。每3月复查MRCT1次,二年生每6月复查MR或CT1次。结果：迄2000年12月25日止共随访54例,随访到53例（98.1%）,失访1例（1.9%）;中位随访时间为15.4个月,平均访时间为14.3个月（3－30个月）。疗效判定标准：按WHO制订标准,完全缓解5例,占9.3%;部分缓解27例,占50.0%。稳定15例,占27.8%;进展6例占11.1%。有效率为59.3%。一年生存率61.1%（33/54）,症状缓解率92.6%（50／54）。放射性肠炎发生率约为5.6%。均未出现白细胞减少和肝、肾功能降低与尿频、尿急、尿痛和血尿。结论：三维适形放射治疗直肠癌术后复发患者具有明显的剂量分布优势,局部控制率和症状缓解率高,放射性肠炎发生率低。

Clinical practice of 3-D conformal radiation therapy for local recurrence of rectal cancer

Objective:This study was designed to investigate the retreatment of local recurrence of rectal cancer with three-dimensional conformal radiation therapy (3-D CRT).Methods:54 patients, owing to irresectable local recurrence, were entered on study. Of which 35 were men, 19 were women, mean age 53.9, range from 27 to 74. Using three-dimensional planing 60-72Gy were delivered to the clinical target volume. The prescription dose-fraction-time was 60-72Gy/22-24f/4.5-6w. Toxicity was clinical assessed by hematology and biochemical tests and adverse events (including gastrointestinal and urinary toxicity). Results:The median follow-up after 3-DCRT was 15.4 months (range:3-30 months). Overall survial at 1 year was 61%. 9.3% of patients achieved a complete response (5/54), and 50.0% a partial response (27/54). Conclusion:We conclude that 3-D conformal radiation therapy has an obvious advantage on dose distribution in the treatment of local recurrence of rectal cancer, and has relatively lower incidence of radiation complication. 3-DCRT provides encouraging results in locally recurrent rectal cancer.