三维适形放疗同步化疗治疗晚期直肠癌的临床观察

目的 观察三维适形放疗同步FOLFOX方案化疗治疗晚期直肠癌的临床疗效和毒副反应。方法 经病理证实的晚期直肠癌（包括局部晚期和远处转移）患者16例，行盆腔三野等中心放疗50Gy。常规分割剂量（2Gy，5次，周），5周内完成，后针对直肠局部肿块行三维适形放疗加量至60Gy-64Gy。放疗前3d开始化疗．化疗方案为静脉滴注奥沙利铂（恒瑞生产，商品名：草酸铂）60rag／m2dl，亚叶酸钙200mg／m^2d1、2，氟尿嘧啶1600mg/min^2静脉持续给药46h，2周1次，2次为1周，共完成92周（184次）。结果 其中有15例按计划完成治疗。1例因未完成治疗周期而不计数在内，疗效评价CR2例（13.3%），PR11例（73．3%），NC2例（13．3%），总有效率为86．7％。14例（93.3％）一般状况改善，12例（80％）生活质量明显提高。主要不良反应为骨髓抑制、消化道反应和末稍神经病变，经相应处理后恢复，无治疗相关死亡。结论 三维适形放疗同步FOLFOX方案化疗治疗晚期直肠癌安全、有效．毒副反应轻，可作为晚期直肠癌新的治疗方案。

Clinical observation of efficacy of three dimensional-conformal radiotherapy concurrent chemotherapy for advanced rectal cancer

Objective To determine the efficacy and toxicities of three dimensional-conformal radiotherapy(3D-CRT)combined with oxaliplatin, fluorouracil and folinic acid chemotherapy for advanced or metastatic rectal cancer. Methods It were treated that 16 patients were confirmed by pathological examination with advanced or metastatic rectal. Pelvic was radiated with 50Gy fractionated conventional external-beam radiotherapy (2Gy,5d/w) for 5 weeks, and then plus 3D-CRT for the local tumor, and the total dose of the local tumor was 60~64Gy. The schedule of concomitant chemotherapy was oxaliplatin 60 mg/m2 2-hour infusion on day 1 followed by folinic acid 200 mg/m2/d intravenous bolus on day 1 and 2, and 5-FU 1600 mg/m2 continuous infusion for 46 hours. The every patients were scheduled to treat 12 vices (6 cycles).Results The overall response rate was 86.7%, with a complete response rate of 13.3% and partial response rate of 73.3%. There were no treatment-related death.Conclusion Three dimensional-conformal radiotherapy combined with oxaliplatin, fluorouracil and folinic acid chemotherapy are safety and efficient for advanced rectal cancer, and it is a well-tolerated regimen.