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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 217 -221. doi: 10.3877/cma.j.issn.1674-6880.2021.03.008

短篇论著

局部晚期直肠癌术前同步放射治疗及化学治疗联合热疗67例疗效分析
刘卓1, 陶金华1, 沈金闻2, 李德川1, 朱玉萍1, 罗加林2,()   
  1. 1. 310022 杭州,中国科学院大学附属肿瘤医院(浙江省肿瘤医院)结直肠肿瘤外科;310022 杭州,中国科学院大学附属肿瘤医院(浙江省肿瘤医院)中国科学院肿瘤与基础研究所
    2. 310022 杭州,中国科学院大学附属肿瘤医院(浙江省肿瘤医院)中国科学院肿瘤与基础研究所;310022 杭州,中国科学院大学附属肿瘤医院(浙江省肿瘤医院)腹部肿瘤放疗科
  • 收稿日期:2021-05-01 出版日期:2021-06-30
  • 通信作者: 罗加林
  • 基金资助:
    浙江省医药卫生科技计划项目(2018KY305); 浙江省自然科学基金项目(Y19H160049)

Clinical analysis of 67 patients with locally advanced rectal cancer treated with preoperative synchronous radiotherapy and chemotherapy combined with hyperthermia

Zhuo Liu1, Jinhua Tao1, Jinwen Shen2   

  • Received:2021-05-01 Published:2021-06-30
引用本文:

刘卓, 陶金华, 沈金闻, 李德川, 朱玉萍, 罗加林. 局部晚期直肠癌术前同步放射治疗及化学治疗联合热疗67例疗效分析[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(03): 217-221.

Zhuo Liu, Jinhua Tao, Jinwen Shen. Clinical analysis of 67 patients with locally advanced rectal cancer treated with preoperative synchronous radiotherapy and chemotherapy combined with hyperthermia[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(03): 217-221.

目的

探讨局部晚期直肠癌(LARC)患者术前同步放射治疗及化学治疗联合热疗的临床疗效。

方法

选取2009年7月至2013年12月在浙江省肿瘤医院确诊为LARC(美国癌症联合委员会分期T3 ~ T4伴或不伴淋巴结转移)的67例患者为研究对象,行术前新辅助放射治疗及化学治疗联合热疗,放射治疗总剂量为50 Gy,放射治疗前1 h内进行热疗(每周2次),持续5周。放射治疗结束4 ~ 6周后对LARC患者进行手术治疗。对所有患者的临床疗效进行评价,并采用Kaplan-Meier绘制生存曲线进行分析。

结果

67例患者中共64例患者接受手术治疗,且均恢复顺利出院;余3例因拒绝切除肛门而放弃手术治疗。96.9%(62 / 64)的患者达到R0切除,89.1%(57 / 64)的患者出现局部降期,23.4%(15 / 64)的患者病理完全缓解(pCR),76.6%(49 / 64)的患者病理示无淋巴结转移(ypN-),Ⅲ级不良反应发生率为14.9%(10 / 67)。术后随访3 ~ 72个月,5年总生存率为81.2%(52 / 64),5年肿瘤无病生存率为70.3%(45 / 64)。同时,pCR患者的生存曲线明显优于非pCR患者( χ2 = 4.132,P = 0.042),ypT0 ~ T2患者的生存曲线明显优于ypT3 ~T4患者( χ2 = 14.791,P < 0.001),ypN-患者的生存曲线明显优于ypN+患者( χ2 = 12.402,P < 0.001)。

结论

新辅助放射治疗及化学治疗联合热疗治疗LARC可以显著提高LARC患者的pCR、R0切除率及保肛率,肿瘤退缩明显,且不会增加治疗相关不良反应,患者耐受性较好。

表1 术前同步放射治疗及化学治疗联合热疗后肿瘤局部降期情况(例)
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