结直肠癌寡转移三维适形调强放疗的临床评价

目的 分析结直肠癌寡转移患者应用三维适形调强放射治疗的疗效和安全性。 方法 回顾性分析蚌埠医学院第一附属医院放疗中心2012年1月—2016年12月期间收治的完成三维适形调强放疗的结直肠癌寡转移患者的临床资料，随访及观察后，经生存分析，评估结直肠癌寡转移行三维适形调强放疗的疗效及安全性。 结果 共纳入结直肠癌寡转移患者48例,接受放疗的转移灶数为88个，肺转移和肝转移的比例分别为45.83%、29.17%，治疗结束后出现复发和转移26例(54.17%)，疾病初诊阶段发生转移22例(45.83%)。1年、2年的局部控制率分别为85.50%和73.69%，局部失败比例达20.83%。1年总生存率(OS)为84.29%，2年为58.32%。患者的1年、2年无进展生存期(PFS)分别为44.01%和22.29%。将多个变量进行单因素分析，其中是否同时性转移患者PFS比较差异有统计学意义(P=0.038)，OS比较差异有统计学意义(P=0.041)，提示非同时性转移患者PFS、OS明显获益，性别、年龄、转移灶数量、是否诱导化疗、肿瘤最大直径等对OS、PFS无显著影响。毒副作用方面主要为放疗过程中出现的急性毒性反应，3级仅有1例，其他均为1~2级，无4级或更严重的毒性反应导致死亡发生，未观察到慢性毒性反应。 结论 结直肠癌寡转移行三维适形调强放疗疗效确切，安全性较高，可作为一种治疗手段供临床放疗时应用和开展。 

Clinical evaluation of three-dimensional conformal intensity modulated radiotherapy for colorectal cancer oligometastases

Objective To assess the efficacy and the safety treated by radiotherapy for colorectal cancer (CRC) oligometastases. Methods CRC oligometastases treated with radiotherapy in our cancer center between January 2012 and December 2016 were included for clinical review. After follow-up and observation, survival analysis was conducted to evaluate the efficacy and safety of oligometastases in patients with colorectal cancer. Results In this study, 48 patients with colorectal cancer oligometastases were enrolled, and the number of metastases receiving radiotherapy was 88. The proportion of lung metastasis and liver metastasis was 45.83% and 29.17%, respectively. There were 26 cases (54.17%) of recurrence and metastasis after treatment, 22 cases (45.83%) occurred in the initial diagnosis of the disease. The 1-year local control rate and 2-year local control rate were 85.50% and 73.69%, respectively. Local failure rate reached 20.83%. The 1-year and 2-year overall survival rates (OS) were 84.29% and 58.32%, respectively. The PFS of patients at 1 year and 2 years were 44.01% and 22.29%, respectively. Univariate analysis showed that the P value of the PFS and OS were 0.038 and 0.041 in patients with Synchronous oligometastases compared with nonsynchronous oligometastases,suggesting that PFS and OS benefit significantly in patients with nonsynchronous oligometastases.Gender, age, number of metastases, induction chemotherapy, maximum diameter of tumors had no significant effect on OS and PFS. The side effects were mainly acute toxicity during radiotherapy. There were only 1 case in grade 3, and others were grade 1-2. No grade 4 or more serious toxicities caused death, and no long-term toxicity was observed. Conclusion Three-dimensional conformal intensity modulated radiotherapy for colorectal cancer oligometastases has definite efficacy and higher safety, which is worthy of clinical promotion and application.