摘要
目的探讨Ⅱ~Ⅲ期直肠癌应用奥沙利铂联合卡培他滨术前同步放化疗的临床疗效及毒副反应。方法收集大连医科大学附属第二医院放疗科2008年至2012年收治的经病理组织学证实的Ⅱ~Ⅲ期直肠癌患者104例,术前均行同步放化疗。三维适形放疗：1.8 Gy/次,DT 50.4 Gy/28次。同步化疗方案：奥沙利铂50 mg/m^2,每周1次,共5次;卡培他滨1650 mg/（m^2·d）,d1~d35。同步放化疗结束后8周进行手术,术后完成6个月的FOLFOX 6方案全身化疗。观察并随访术前同步放化疗后疗效及不良反应。结果同步放化疗后肿瘤降期率为55.8%（58/104）,术后完全缓解（CR）22例,部分缓解（PR）67例,稳定（SD）15例,有效率（RR）为85.6%（89/104）。总体保肛率为78.8%（82/104）。不良反应主要为腹泻、恶心、呕吐、骨髓抑制及口腔炎等,仅1例4级不良反应发生,无放化疗相关死亡。3年生存率、无病生存率、远处转移率及局部复发率分别为90.3%、74.0%、24.0%和3.9%。结论Ⅱ~Ⅲ期直肠癌奥沙利铂联合卡培他滨术前同步放化疗能降低肿瘤分期,提高肿瘤病理完全缓解率,且不良反应可耐受,局部控制可,但并未明显降低远处转移率,其结果仍需长期随访。
Objective To explore the effectiveness and toxicity for patients with stage Ⅱ and Ⅲ rectal cancer after preoperative radiation and concurrent oxaliplatin plus capecitabine. Methods A hundred and four patients with histopathologically proven rectal cancer and clinical stage Ⅱ-Ⅲ in the Department of Radiation Oncology of the Second Affiliated Hospital of Dalian Medical University from 2008 to 2012 were enrolled in prospective studies. The radiation regimen consisted of 50. 4 Gy /28 fractions and the concurrent chemotherapy was oxaliplatin plus capecitabine,（ oxaliplatin 50 mg / m^2 per week for 5 times and capecitabine 1650 mg / m^2 in bid from d1-d35）. Radical surgery was performed 8 weeks after chemoradiotherapy. FOLFOX 6 chemotherapy protocol was given perioperatively for 6 months. Results The down-staging rate of 104 patients was 55. 8%（ 58 /104） after preoperative chemoradiation. There were 22 cases of CR,67 cases of PR and 15 cases of SD and the response rate（ RR） was 85. 6%（ 89 /104）. The sphincter preservation rate was 78. 8%（ 82 /104）. The main adverse reactions were diarrhea,nausea,vomiting,myelosuppression and stomatitis. Only one grade4 toxicity was observed. No chemoradiation related death was observed. The 3-year overall survival,disease free survival,distant metastasis rate and local recurrence rate for all patients were 90. 3%,74. 0%,24. 0%,3. 9%,respectively. Conclusion Delivering oxalipatin plus capecitabine in combination with radiation for stage Ⅱ and Ⅲ rectal cancer can bring tumor staging down and increase complete pathological response. The adverse reactions are tolerable for patients and the local control is excellent,but it can＇t reduce the distant metastasis rate,which need more follow-up.
出处
《临床肿瘤学杂志》
CAS
2015年第10期918-921,共4页
Chinese Clinical Oncology
关键词
直肠肿瘤
同步放化疗
存活率
Rectal cancer
Concurrent chemoradiotherapy
Survival rate
