张术,王小豪,肖巍魏,王俏镟,曾智帆,丁培荣,陈功,潘志忠,万德森,高远红

• 1:华南肿瘤学国家重点实验室中山大学肿瘤防治中心放射治疗科
• 2:华南肿瘤学国家重点实验室中山大学肿瘤防治中心结直肠科

摘要(Abstract)：

目的通过分析高剂量放疗联合化疗治疗放弃手术的直肠癌患者的疗效及不良反应,探讨高剂量放疗治疗特定直肠癌人群的可行性。方法 52例放弃手术的直肠癌患者接受高剂量放疗联合化疗。放疗技术采用三维适形放疗(three dimensional conformal radiation therapy,3D-CRT)或调强放射治疗(intensity modulated radiation therapy,IMRT);治疗前明确放弃手术者给予一程高剂量放疗:大体肿瘤靶区(gross tumor volume,GTV)60~70 Gy/30~35 F(中位66 Gy),临床靶区(clinical target volume,CTV)45~50 Gy/25 F;新辅助或诱导放化疗后未达到临床完全缓解(clinical complete response,c CR)而又放弃手术者给予二程推量放疗:第一程GTV 45~50 Gy/25 F、CTV45~46 Gy/25 F,第二程推量放疗GTV 30 Gy/15 F,中位总剂量80 Gy,两程放疗间隔期中位时间71 d。分析全组、局部进展期直肠癌亚组以及全程治疗后获得临床完全缓解亚组患者的局部复发率或进展率、生存率及不良反应。结果中位随访30个月,全组3年无局部进展生存率(local progression free survival,LPFS)、无进展生存率(progression free survival,PFS)和总生存率(overall survival,OS)分别为80.4%、65.7%和84.2%。局部进展期患者3年局部进展率13.6%,3年LPFS、PFS和OS分别为84.6%、68.1%和87.5%。治疗后获c CR者局部复发率12.9%,3年LPFS、PFS和OS分别为85.2%、73.9%和96.8%。无4~5级严重急性不良反应发生,远期需要医疗干预的放射性直肠炎发生率为5.8%。结论高剂量放疗联合化疗治疗放弃手术的特定直肠癌人群可获得满意的临床疗效,急性及远期放疗毒性可以接受。

关键词(KeyWords)： 直肠肿瘤/放射疗法;直肠肿瘤/药物疗法;放射治疗剂量;存活率;综合疗法;治疗结果;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张术,王小豪,肖巍魏,王俏镟,曾智帆,丁培荣,陈功,潘志忠,万德森,高远红

DOI: 10.13267/j.cnki.syzlzz.2018.02.002

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