CAJ | 학술논문

目的分析局部复发不能手术切除的直肠癌患者,采用超常规大分割放疗同步口服卡培他滨化疗的疗效、影响因素及不良反应.方法选取2006年1月至2013年1月,本院收治的52例直肠腺癌术后局部复发的患者,均采用调强放疗(IMRT)技术,照射复发肿瘤区,肿瘤中位剂量63.4 Gy(61.6 ～64.4 Gy),2.2～2.3 Gy/次,5次/周;13例进行盆腔淋巴结预防照射采用同步补量IMRT技术,剂量45 ～ 50.4 Gy,1.8 ～2.0 Gy/次.全部患者均接受同步化疗,每天口服卡培他滨1 650 mg/m2,连续5 d/周.分析局部控制率(LC)、总生存率(OS)及不良反应.结果全部患者完全缓解(CR)、部分缓解(PR)、稳定(SD)及局部进展(PD)分别为23.1％、38.5％、32.7％和5.8％.既往盆腔放疗与未放疗的有效率(CR+ PR)分别为37.1％和71.1％(x2=5.40,P＜0.05);单一区域复发疗效优于两个及以上区域复发者,有效率分别为81.8％和46.7％(x2 =6.63,P＜0.05).早期严重不良反应包括:3级皮肤反应19例(36.5％),3级血液学不良反应1例(1.9％).4例患者晚期发生重度吻合口狭窄行横结肠造瘘.5年LC和OS分别为49.1％和23.1％.结论局部复发直肠癌单纯局部大分割高剂量放疗同步口服卡培他滨化疗是可行的,早晚期不良反应可耐受,有较好的近期疗效和长期控制率.
목적 분석국부복발불능수술절제적직장암환자,채용초상규대분할방료동보구복잡배타빈화료적료효、영향인소급불량반응.방법 선취2006년1월지2013년1월,본원수치적52례직장선암술후국부복발적환자,균채용조강방료(IMRT)기술,조사복발종류구,종류중위제량63.4 Gy(61.6 ～64.4 Gy),2.2～2.3 Gy/차,5차/주;13례진행분강림파결예방조사채용동보보량IMRT기술,제량45 ～ 50.4 Gy,1.8 ～2.0 Gy/차.전부환자균접수동보화료,매천구복잡배타빈1 650 mg/m2,련속5 d/주.분석국부공제솔(LC)、총생존솔(OS)급불량반응.결과 전부환자완전완해(CR)、부분완해(PR)、은정(SD)급국부진전(PD)분별위23.1％、38.5％、32.7％화5.8％.기왕분강방료여미방료적유효솔(CR+ PR)분별위37.1％화71.1％(x2=5.40,P＜0.05);단일구역복발료효우우량개급이상구역복발자,유효솔분별위81.8％화46.7％(x2 =6.63,P＜0.05).조기엄중불량반응포괄:3급피부반응19례(36.5％),3급혈액학불량반응1례(1.9％).4례환자만기발생중도문합구협착행횡결장조루.5년LC화OS분별위49.1％화23.1％.결론 국부복발직장암단순국부대분할고제량방료동보구복잡배타빈화료시가행적,조만기불량반응가내수,유교호적근기료효화장기공제솔.
Objective To analyze the response rate and prognostic factors for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresection.Methods Totally 52 patients with locally recurrent rectal cancer received hypofractionated irradiation and concurrent chemotherapy from January 2006 to January 2013 were enrolled.All patients received intensity-modulated radiotherapy (IMRT).The median dose was 63.4 Gy (61.6-64.4 Gy) at 2.2-2.3 Gy/f,5 f/week.Thirteen patients underwent prophylactic irradiation at lymph nodes region,the total dose of 45-50.4 Gy with conventional fraction and a simultaneous integrated boost was used.All patients received concurrent chemotherapy,capecitabine at 1 650 mg·m-2 ·d-1,divided into 2 times,5 d/week.The variables were compared by the chi-square test or Fisher's exact test.Local control (LC) and overall survival (OS) were calculated with using the Kaplan-Meier method.Results For all patients,the clinical complete response (CR),partial response (PR),stable disease (SD) and progressive disease (PD) was 23.1％,38.5％,32.7％ and 5.8％,respectively.The response rate (CR + PR) for patients with previous irradiation to pelvis and without were 37.1％ and 71.1％,respectively (x2 =5.40,P ＜ 0.05);for patients with 1 and 2 or more recurrent subsites were 81.8％ and 46.7％,respectively (x2 =6.63,P ＜ 0.05).Acute grade 3 skin and hematologic toxicities occurred in 19 patients (36.5％) and 1 patient (1.9％),respectively.None occurred grade 4 toxicity and none occurred grade 3 or more gastrointestinal and urologic toxicities.Four patients showed severe late toxicity of anastomotic stricture and performed a stoma at transverse colon.No other severe late toxicities were observed.The LC at 5 years was 49.1％ and the OS was 23.1％.Conclusions For patients with locally recurrent rectal cancer,hypofractionated chemoradiotherapy without resection is an acceptable and effective regimen,the response rate and long-term outcomes are promising.