局部进展期直肠癌术前新辅助IMRT与3D-CRT的疗效对比分析
摘要
目的比较术前三维适形放疗(3D-CRT)及调强放疗(IMRT)联合化疗用于局部进展期直肠癌(LARC)的近期疗效、耐受性,并随访比较两组无进展生存时间(PFS)及总生存时间(OS)。方法回顾性收集2010年5月至2016年3月在本院行术前3D-CRT或IMRT联合同期化疗后手术的133例LARC患者的病例资料,其中3D-CRT组71例,IMRT组62例。IMRT组:PTV1 50. 4 Gy/2. 0 Gy×25F,PTV2 46 Gy/1. 84 Gy×25F; 3D-CRT组PTV2 46 Gy/1. 84 Gy×25F。两组放化疗期间急性不良反应评价参照CTCAE 3. 0标准,比较两组放化疗期间不良反应发生情况、手术情况、术后并发症及术后病理降期;随访比较两组PFS及OS。结果同期放化疗期间,两组中位剂量、放疗中断率、2级及3级血液学及非血液学不良反应发生率比较,差异均无统计学意义(P> 0. 05)。两组均无4级不良反应的发生;均为全直肠系膜切除术;术后并发症比较差异均无统计学意义(P> 0. 05)。IMRT组术后4级病理降期率为25. 8%,3D-CRT组为15. 5%,差异无统计学意义(P> 0. 05); IMRT、3DCRT组3级以上病理降期率分别为45. 2%和25. 4%,差异有统计学意义(χ2=5. 741,P=0. 017)。IMRT、3D-CRT组术后中位PFS分别为36. 5、30. 0个月,差异有统计学意义(P=0. 000);中位OS分别为41. 5、36. 0个月,差异有统计学意义(P=0. 000)。结论 LARC新辅助调强放疗为可行的治疗方案,与三维适形放疗相比提高了病理降期,延长生存期并降低复发,有待更高的局部加量进一步提高疗效。
引文
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[15]李宗林,姚晖,夏冬,等.进展期直肠癌Dixon手术IITIC的临床价值[J].中国医师杂志,2018,20(3):364-366,370.DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 03. 012.
[2] Yoon WH,Kim HJ,Kim CH,et al. Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer[J]. Ann Surg Treat Res,2015,88(1):15-20. DOI:10. 4174/astr. 2015. 88. 1. 15.
[3] Appelt AL,Plen J,Vogelius IR,et al. Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy[J]. Int J Radiat Oncol Biol Phys,2013,85(1):74-80. DOI:10. 1016/j. ijrobp. 2012. 05. 017.
[4] Arbea L,Ramos LI,Martínez-Monge R,et al. Intensity-modulated radiation therapy(IMRT)vs. 3D conformal radiotherapy(3DCRT)in locally advanced rectal cancer(LARC):dosimetric comparison and clinical implications[J]. Radiat Oncol,2010,5:17. DOI:10. 1186/1748-717X-5-17.
[5] Vazquez MD,Ferraris G,Bianchi A,et al. Clinical comparison of IMRT with 3D-CRT in preoperative chemoradiation therapy for locally-advanced rectal cancer(LARC)[J]. Int J Radiat Oncol Biol Phys,2013,87(S2):S329. DOI:10. 1016/j. ijrobp.2013. 06. 867.
[6] Gérard JP,Azria D,Gourgou-Bourgade S,et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer:results of the phase III trial ACCORD 12/0405-Prodige 2[J]. J Clin Oncol,2010,28(10):1638-1644. DOI:10.1200/JCO. 2009. 25. 8376.
[7] Gérard JP,Azria D,Gourgou-Bourgade S,et al. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer[J]. J Clin Oncol,2012,30(36):4558-4565. DOI:10.1200/JCO. 2012. 42. 8771.
[8] Burbach JP,den Harder AM,Intven M,et al. Impact of radiotherapy boost on pathological complete response in patients with locally advanced rectal cancer:a systematic review and meta-analysis[J]. Radiother Oncol,2014,113(1):1-9. DOI:10. 1016/j.radonc. 2014. 08. 035.
[9] Ballonoff A,Kavanagh B,Mc Carter M,et al. Preoperative capecitabine and accelerated intensity-modulated radiotherapy in locally advanced rectal cancer:a phase II trial[J]. Am J Clin Oncol,2008,31(3):264-270. DOI:10. 1097/COC. 0b013e318161dbd3.
[10]杨咏强,冯林春,贾宝庆,等.局部中晚期直肠癌术前同期加量调强放疗前瞻性临床研究的初步结果[J].中华放射医学与防护杂志,2013,33(5):512-515. DOI:10. 3760/cma. j.issn. 0254-5098. 2013. 05. 014.
[11]肖林,黄蓉,游凯云,等.局部进展期直肠癌术前新辅助放化疗中VMAT的可行性研究[J].中华放射肿瘤学杂志,2014,23(1):9-13. DOI:10. 3760/cma. j. issn. 1004-4221. 2014. 01.003.
[12]杨咏强,冯林春,王运来,等. VMAT应用于直肠癌术前同期加量放疗的剂量学研究[J].中华放射肿瘤学杂志,2014,23(5):400-401. DOI:10. 3760/cma. j. issn. 1004-4221. 2014. 05.008.
[13] Zhu J,Liu F,Gu W,et al. Concomitant boost IMRT-based neoadjuvant chemoradiotherapy for clinical stage II/III rectal adenocarcinoma:results of a phase II study[J]. Radiat Oncol,2014,9:70. DOI:10. 1186/1748-717X-9-70.
[14] Hernando-Requejo O,López M,Cubillo A,et al. Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation[J]. Strahlenther Onkol,2014,190(6):515-520. DOI:10. 1007/s00066-014-0650-0.
[15]李宗林,姚晖,夏冬,等.进展期直肠癌Dixon手术IITIC的临床价值[J].中国医师杂志,2018,20(3):364-366,370.DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 03. 012.