摘要
目的 评估对Ⅱ～Ⅲ期可手术切除的直肠癌患者行术前同期加量调强放疗（SIB-IMRT）并同步口服卡培他滨化疗的可行性、安全性及近期疗效.方法 2012年8月至2013年5月间共13例Ⅱ～Ⅲ期可手术切除的直肠癌患者接受术前调强放疗,给予肿瘤原发病灶及转移淋巴结56.25 Gy/25次（2.25 Gy/次）,高危复发区域和区域淋巴引流区50 Gy/25次（2.0 Gy/次）,同时口服卡培他滨同步化疗（825 mg/m2,2次/d,5 d/周×5周）.放化疗结束后4～8周患者接受全直肠系膜切除术（TME）.研究主要终点为病理完全缓解率（ypCR率）、TNM降期率、急性期不良反应及术后并发症发生率,次要终点为保肛手术率.结果 所有患者顺利完成术前同步放化疗并接受TME,TNM降期率为10/13,其中T降期率为9/13,N降期率为4/6,ypCR率为3/13.放化疗期间不良反应全部为1～2级,包括2级骨髓抑制5例,1级骨髓抑制4例,1级腹泻2例.1例患者术后出现膀胱瘘.保肛手术率为10/13.结论 局部中晚期直肠癌患者行SIB-IMRT并口服卡培他滨的术前同步放化疗方案的初步结果表明其疗效好、安全可行、不良反应发生率低.
Objective To evaluate the feasibility,safety,and short-term efficacy of preoperative capecitabine and simultaneous integrated boost（SIB）intensity-modulated radiotherapy（IMRT）in patients with locally advanced rectal cancer.Methods Between August 2012 and May 2013,a total of 13 patients with resectable stage Ⅱ or Ⅲ rectal cancer received capecitabine（825 mg/m2 P.O,twice a day,5 d/week for 5 weeks）and SIB-IMRT delivering 56.25 Gy（2.25 Gy/fraction）to the gross tumor while simultaneously delivering 50 Gy（2.0 Gy/fraction）to the regional lymph nodes and areas at risk for harboring microscopic disease.Total mesorectal excision was scheduled 4 to 8 weeks after the completion of chemoradiation.The primary endpoints included pathological complete response rate（ypCR）,tumor downstaging,toxicity and postoperative complications.The secondary endpoint included the rate of sphincter-sparing surgery.Results All patients completed chemoradiation with strict compliance to the protocol schedule and then went on to surgical resection.Three patients had no residual tumor in the surgical specimen.Downstaging of the primary tumor and lymph nodes was observed in 9 and 4 patients,respectively.Grade 1 or 2 toxicities included leucopenia,thrombocytopenia and diarrhea.One patient developed vesical fistula after surgery.Ten patients underwent sphincter-sparing procedures.Conclusions Preoperative chemoradiation with capecitabine and SIB-IMRT can be safe and well tolerated for patients with locally advanced rectal cancer and the short term outcomes could be promising.
出处
《中华放射医学与防护杂志》
CAS
CSCD
北大核心
2013年第5期512-515,共4页
Chinese Journal of Radiological Medicine and Protection
关键词
直肠癌
调强放疗
卡培他滨
Rectal cancer
Intensity-modulated radiation therapy
Capecitabine
