【作者】 胡静；

【导师】 田野； 朱雅群；

【作者基本信息】 苏州大学 ， 肿瘤学（专业学位）， 2016， 硕士

【摘要】 目的:手术是直肠癌最主要治疗手段,但单纯手术治疗后复发率较高,因此术前或术后放化疗已成为Ⅱ、Ⅲ期直肠癌的标准治疗方法。随着IMRT的广泛临床应用,其疗效如何?不良反应是否更低?本研究旨在探讨直肠癌术后IMRT±化疗的疗效及预后影响因素。方法:回顾性分析2009年01月~2013年12月经我科收治的218例直肠癌术后IMRT患者的临床资料。调查内容包括患者一般情况、肿瘤情况、治疗方法、急性不良反应(CTCAEv3.0标准)和生存情况。共208例(95.4%)患者进行了化疗,方案以氟尿嘧啶类药物为主。采用Kaplan-Meier法计算生存率,Log-rank检验和单因素预后分析,Cox模型行多因素预后分析。结果:截止2014年11月30日,共5例患者失访,随访率97.7%。整组患者的1、3年OS率分别为90.8%、75.2%,DFS率分别为85.3%、70.5%,LRFS率分别为96.7%、88.1%。其中同期放化疗组与序贯放化疗组的3年OS率(80.1%:72.4%)、DFS率(75.3%:67.3%)和LRFS率(93.3%:84.9%)均未见明显差异(P=0.100、0.066、0.107)。全组3~4级急性不良反应发生率为28.4%,主要表现为3级白细胞减少(13.8%)和腹泻(11.0%)。同期放化疗组白细胞减少(76.4%:63.2%,P=0.132)、贫血(51.4%:29.4%,P=0.003)、腹泻(51.4%:44.1%,P=0.178)、放射性皮炎(29.3%:25%,P=0.351)及肝功能损伤(30.7%:10.3%,P=0.001)的发生率较序贯放化疗组高。单因素预后分析表明,术前CEA、CA199水平、肿瘤最大径、肿瘤部位、分化程度、肿瘤浸润深度、淋巴结转移数、TNM分期、神经侵犯、手术方式、TME、术前肠梗阻和术前贫血为影响因素(P=0.006、0.000、0.000、0.017、0.000、0.016、0.000、0.011、0.001、0.001、0.006、0.037和0.010);多因素预后分析显示,术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为影响因素(P=0.000、0.000、0.000、0.001和0.001)。结论:直肠癌术后IMRT±化疗疗效肯定,不良反应轻,治疗依从性较高。术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血是影响患者预后的独立因素。更多还原

【Abstract】 Objective: Surgery is the main treatment of rectal cancer, with higher recurrence rate after surgery alone, so the preoperative/postoperative chemoradiotherapy has been standard treatment for locally advanced rectal cancer. Intensity- modulated radiotherapy(IMRT) has been applied widely in clinical practice, but how about its efficacy and whether its toxicity is lower? This study aimed to explore the efficacy and prognostic factors of postoperative IMRT with or without chemotherapy in rectal cancer.Methods: A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013. Data regarding patient and tumor characteristics, treatment, acute toxicity according to the NCI-CTCAE v3.0, survival and tumor status were collected. A total of 208 patients(95.4%) received chemotherapy, fluorouracil were the main treatment drugs. The Kaplan-Meier method was used to calculate survival rate; the log-rank test was used for survival difference analysis and univariate prognostic analysis; the Cox regression model were used for multivariate prognostic analysis.Results: By November 30, 2014, 5 patients were lost to follow-up, the follow-up rate 97.7%. The 1-and 3- overall survival rates were 90.8% and 75.2%, respectively; the 1-and 3- disease-free survival rates were 85.3% and 70.5%, respectively; and the 1-and 3-locoregional recurrence-free survival rates were 96.7% and 88.1%, respectively. There were no significant differences between concurrent chemoradiotherapy(CCRT) group and sequential chemoradiotherapy(SCRT) group in 3-year overall survival rates(80.1% : 72.4%, P=0.100), 3-year disease-free survival rates(75.3% : 67.3%, P=0.066) and 3-year locoregional recurrence-free survival rates(93.3% : 84.9%, P=0.107). The incidence of grade 3~4 acute adverse reactions was 28.4%, mainly manifested as leukopenia(13.8%) and diarrhea(11.0%). Compared with the SCRT group, the incidence of leukopenia(76.4% : 63.2%, P=0.132), anemia(51.4% : 29.4%, P=0.003), diarrhea(51.4% : 44.1%, P=0.178), radiation-induced dermatitis(29.3% : 25%, P=0.351) and hepatic injury(30.7% : 10.3%, P=0.001) was higher in the CCRT group. Univariate prognostic analysis showed that preoperative carcinoembryonic antigen(CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differenation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival(P=0.006, 0.000, 0.000, 0.017, 0.000, 0.016, 0.000, 0.011, 0.001, 0.001, 0.006, 0.037 and 0.010). Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction and preoperative anemia were the predictors of survival(P=0.000, 0.000, 0.000, 0.001 and 0.001).Conclusions: Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction and preoperative anemia are independent prognostic factors for the overall survival.更多还原