三维适形放射配合化疗治疗局部晚期和术后复发性直肠癌

目的　探讨局部晚期和术后复发性直肠癌三维适形放射治疗 (3DCRT)配合化疗的临床疗效。方法　 2 4例局部晚期和术后复发性直肠癌均在外照射 4 4Gy后进入 3DCRT ,采用 3DCRT结合氟尿嘧啶为主型同步化疗 (综合组 ) 11例 ,单独应用 3DCRT(对照组 ) 13例。结果　综合组和对照组疼痛缓解率分别为 90 .9%和 84 .6 % ,有效 (CR PR)率分别为 90 .9%和 6 9.2 % ,2个组差异均无显著性意义 (P值均 >0 .0 5 )。 2个组 2年生存率分别为 6 3.6 %、38.5 % ,生存率比较综合组优于对照组 (χ2 =6 .12 ,P =0 .0 13) ;2年局部控制率分别为 72 .7%、6 1.5 % ,差异无显著性意义 (χ2 =3.74 ,P =0 .0 5 3) ;远地转移率分别为 36 .3%、6 1.5 % ,差异有极显著性意义 (χ2 =7.39,P =0 .0 0 7)。在毒副反应方面 2个组相似 (P >0 .0 5 )。结论　局部晚期和术后复发性直肠癌临床行外放射 三维适形放射治疗配合化疗可明显减少远地转移率和提高患者的近期生存率。

Three dimensional-conformal radiotherapy combined with chemotherapy for locally advanced or recurrent

Objective To study the outcome of locally advanced or recurrent rectal cancer treated by three dimensional conformal radiotherapy(3D-CRT) combined with chemotherapy(CT). MethodsTwenty-four patients with locally advanced or recurrent rectal cancer were irradiated by external beam radiotherapy to a total dose of 44 Gy,then randomized to receive 3D-CRT plus CT (combined group) or 3D-CRT alone (control group),with 11 patients in the former and 13 in the latter. The chemotherapy regimen included 5-Fu and CF. ResultsThe pain-alleviation rates were 90.9% and 84.6%,while the overall response(CR PR) rates were 90.9% and 69.2% in the combined and control group,with the difference insignificant(P>0.05). Yet,for the combined and control groups,the 2-year survival rates were 63.6% and 38.5%,with the difference significant (P= 0.013 ). The 2-year local control rates were 72.7% and 61.5%,with the difference insignificant (P=0.053). The 2-year distant metastasis rates were 36.3% and 61.5%,with the difference significant (P=0.007). The side effects were similar in the two groups (P>0.05). ConclusionsConventional radiotherapy plus three dimensional conformal radiotherapy combined with chemotherapy may significantly improve the survival rate and reduce the distant metastasis rate of locally advanced or recurrent rectal cancer.