摘要
目的探讨术前口服卡培他滨与放疗联合治疗直肠癌的疗效。方法对临床分期属T3/T4、肿块距肛缘3～9cm、无远处转移或侵犯肛管的局部进展期低位直肠癌患者,给予口服卡培他滨1250mg/m2,2次/日,3周为1个疗程,重复2个疗程;同时给予盆腔常规放疗,总剂量为46～50Gy,2Gy/天。放疗结束后休息3～4周,按TME原则行根治性切除术。结果入组共84例,其中5例患者肿瘤临床完全消退,未手术予于随访。79例患者行根治性手术(RO),实际保留肛门括约肌功能者80例(95.24%)。13例患者术后病理检查结果显示肿瘤完全消退,加上肿瘤临床完全消退,肿瘤完全消退率(CR)达21.43%,未见疾病进展者(PD)。按DWORAK’S肿瘤消退分级(TRG),TRG03例,TRG112例,TRG28例,TRG343例,TRG418例,病理有效率或降期(TRG2+3+4)为82.14%。病例均获得随访,随访时间5～25个月,中位随访时间14个月。局部复发1例(1.19%),肺转移1例,肝转移2例,远处转移率为3.57%,总复发率为4.76%,1年无病生存率(DFS)为86.74%,1年总生存率(OS)为98.51%。3级不良反应有手足综合症2例(2.40%),3度骨髓抑制1例。结论采用口服卡培他滨辅助放、化疗是高度安全有效的。术前口服卡培他滨与放疗联合治疗,绝大多数患者肿瘤完全消退(TRG4)和中度消退(TRG2+3),明显提高了切除率和保肛手术率,疗效确切。
Objective To evaluate the efficacy of preoperative oral capecitabine combined with radiation （RT） on locally advanced low rectal cancer. Methods Patients with T3/T4 tumors located 3 to 9 cm from the anal verge, without distant metastases or extension to the anal canal , were treated by radiotherapy of 46 - 50 Gy in 2Gy per fraction and concomitant oral capecitabine 1 250 mg/（ m2·d） for 2 cycles of 3 weeks. Surgery was carried out 3 - 4weeks following completion of the chemoradiotherapy. Results Eighty - four patients were enrolled in this study. Five patients showed a clinical complete response and were followed up without surgery. Seventy - nine patients received curative （RO） resection and 80 cases of them retain anal sphincter function （95.24%）. Pathologically, 13 patients showed a complete response plus clinical complete response, with an overall complete response rate of 21.43%. There was no disease progression. According to Dworak＇s tumor regression grading （TRG） ,there were 3 cases of TGR0,12 of TGR1,8 of TGR2,43 of TGR3 and 18 of TGR4. The pathological response rate （ TGR 2 ＋3 ＋4） or downstaging occurred in 82.14% of patients. All patients were followed up with a median follow - up time of 14 months （5-25 months）. Local recurrence occurred in 1 patient （1.19%）, lung metastases in 1 patient and liver metastases in 2 patients, with a distant metastatic rate of 3.57% and overall recurrence rate of 4.76%. The disease -free survival （DFS） was 86.74% and overall survival （OS） was 98.51%. Grade 3 toxicities included 2 cases （2.40%） of hand - foot syndrome 1 patient of myelosuppression. Conclusion Preoperative radioehemotherapy with capecitabine is highly effective and safe, and the results from this study are extremely encouraging. Most patients can achieve complete （ TGR 4） , and intermediate pathologic responses （ TGR 2 ＋ 3 ）, resulting in improved DFS and OS, and increased curative resectability and sphincter preservation.
出处
《实用癌症杂志》
2010年第2期181-184,共4页
The Practical Journal of Cancer
关键词
直肠癌
新辅助放化疗
卡培他滨
Rectal cancer
Neoadjuvant radiochemotherapy
Capeeitabine
