适形放疗联合XELOX化疗治疗直肠癌术后复发预后分析

 目的 探讨三维适形放疗（3DCRT）结合奥沙利铂和卡培他滨(XELOX)化疗治疗直肠癌局部复发患者生存时间的影响因素，比较该放化疗不同时序治疗方式对直肠癌术后复发患者的疗效。 方法 随访经3DCRT放疗联合XELOX化疗的83例直肠癌局部复发患者，收集并分析影响其预后的相关临床病理因素。应用Kaplan Meier方法计算生存率，Cox风险模型分析了解病人预后的独立影响因素。83例患者中39例采用3DCRT放疗同步XELOX方案化疗（同步放化疗组），44例采用3DCRT放疗序贯XELOX化疗（序贯放化疗组），比较不同时序放化疗治疗对患者疗效及预后差别。 结果 单因素分析显示治疗方式、肿瘤大小、复发部位、病理类型对生存率有影响，其中同步放化疗组和序贯放化疗组1、2、3年累积 生存率分别为89．3％、68.5％、47.2％及83.3％、56.0％、27.4％。Cox多因素分析显示治疗方式、 肿瘤大小及肿瘤病理类型是独立的预后影响因素。同步放化疗组和序贯放化疗组有效率（CR＋PR）分别为66.7％和 43.2％（P<0．05）；局部控制率分别为92.3％和73.5％（P<0.05）；两组毒性反应主要为白细胞 减少、腹泻和恶心呕吐及外周神经反应。在毒副反应方面两组相似（P>0．05）。 结论 治疗方式、肿瘤大小及肿瘤病理类型是直肠癌复发患者独立的预后影响因素。三维适行放射同步XELOX化疗为直肠癌复发患者可耐受的综合治疗方式，同步联合应用可取得增效、增敏、优势互补的作用。

Prognotic Analysis of Recurrent Rectal Cancer by Treatment of Combining 3DCRT and XE LOX

Objective To explore the factors related the prognosis of recurrent rectal cancer （CRC）by the treatment of 3 dimensional conformal radiotherapy(3DCRT) and capecitabine and oxaliplatin (XELOX) chemotherapy and to compare the efficiency of concurrent chemoradiotherapy with sequent chemoradiotherapy in recurrent rectal cancer. Methods Eighty three cases with recurrent CRC were selected in the study and clinical/pathological factors were collected and patients were follow up. Kaplan Meier method was used to calculate survival rate. Log rank test and proportional hazards regression model （Cox model） were used for univariate and multivariate analysis of prognosis. Thirty nine cases were given concurrent chemoradiotherapy and 44 cases were given sequent chemoradiotherapy. Results Single factor analysis indicated that tumor therapeutic measure, diameter of tumor, the location of recurrent CRC，type of histology were significantly influential factors of the prognosis. One, two and three year survival rates of concurrent chemoradiotherapy and sequent chemoradiotherapy were 89.3%,68.5%,47.2% and 83.3%,56.0%,27.4%, respectively. Tumor therapeutic measure, diameter of tumor, type of histology were independent prognostic factors of recurrent CRC. The overall response rate(CR+PR) in concurrent and sequent 3DCRT and XELOX chemoradiotherapy were 66.7% and 43.2%, respectively （P<0．05）. Disease control rate (CR+PR+SD) were 92.3% and 73.5%(P<0.05）,respectively. There were similar side effects in the concurrent and sequent 3DCRT and XELOX chemoradiotherapy group. Conclusion 3DCRT with concurrent XELOX chemotherapy can be considered as an effective and feasible approach to recurrent CRC patients and the concurrent chemoradiotherapy may improve efficiency sensitization, and complement each other.