盆腔短程姑息放疗在晚期直肠癌中的疗效观察

丁叔波; 周真珍; 李明; 胡望远

doi:10.16766/j.cnki.issn.1674-4152.002268

盆腔短程姑息放疗在晚期直肠癌中的疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002268

浙江大学医学院附属金华医院放疗科，浙江金华 321000

基金项目:

浙江省医药卫生科技计划项目 2020KY1002

金华市科学技术研究计划重点项目 2012-3-010

详细信息

通讯作者:
胡望远, E-mail: huwangyuan@sohu.com

中图分类号: R735.37 R730.55
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- 文章访问数: 242
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-29
- 网络出版日期: 2022-03-03

Efficacy of pelvic short-course palliative radiotherapy for advanced rectal cancer

Department of Radiation Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的评估盆腔短程姑息放疗在合并局部症状晚期直肠癌中的疗效及安全性，为晚期直肠癌姑息放疗提供治疗策略。方法选取2016年5月—2020年4月就诊于浙江大学医学院附属金华医院共51例晚期直肠癌患者为研究对象。年龄为43~74岁，中位年龄为61岁；男性28例，女性23例；51例患者中合并疼痛、出血、肠梗阻比例分别为66.7%(34/51)、68.6%(35/51)、39.2%(20/51)；51例患者均进行盆腔5 Gy×5F短程放疗。采用0~3分症状评分法，比较患者治疗前后疼痛、出血、肠梗阻症状评分变化，评估短程放疗毒副反应及症状持续缓解时间。结果 51例患者疼痛完全缓解率为61.8%(21/34)，部分缓解率为29.4%(10/34)；直肠出血完全缓解率为74.3%(26/35)，部分缓解率为20.0%(7/35)；肠梗阻完全缓解率为55.0%(11/20)，部分缓解率为35.0%(7/20)。整体症状完全缓解率为21.6%，部分缓解率为43.1%，盆腔放疗毒副反应轻微。疼痛、出血、梗阻的中位有效持续时间分别为6.5个月、8.9个月及3.8个月，5例初始无法切除及8例潜在可切除晚期患者进行了根治性手术切除。1例梗阻初始评分为2分的患者在放疗后5.5个月进行了肠造口术。总体1年、2年、3年的生存率分别为86.3%(44/51)、62.7%(32/51)、45.1%(23/51)。结论盆腔5 Gy×5F短程放疗对有合并症的晚期直肠癌具有良好的姑息减症作用，部分肠梗阻患者避免了肠造口术，提高了晚期直肠癌进行根治性手术率，对晚期直肠癌转化治疗有重要的意义。
- 晚期直肠癌 /
- 短程姑息放疗 /
- 疼痛 /
- 出血 /
- 梗阻
Abstract: Objective To evaluate the efficacy and safety of pelvic short-course palliative radiotherapy in advanced rectal cancer with local symptoms, and to provide treatment strategies for palliative radiotherapy for advanced rectal cancer. Methods Total 51 patients with advanced rectal cancer who were admitted to Affiliated Jinhua Hospital, Zhejiang University School of Medicine from May 2016 to April 2020 were selected as the research subjects. The age ranged from 43 to 74 years, and the median age was 61 years old. There were 28 males and 23 females. The rates of pain, bleeding and intestinal obstruction in 51 patients were 66.7%(34/51), 68.6%(35/51), 39.2%(20/51), respectively. All 51 patients were underwent pelvic 5 Gy×5F short-course radiotherapy. The changes in the scores of pain, bleeding and intestinal obstruction symptoms before and after treatment were compared using the symptom score of 0-3 method. The side effects of short-course radiotherapy and the duration of symptom relief were assessed. Results In 51 cases, the complete and partial relief of pain was 61.8%(21/34) and 29.4%(10/34), the complete and partial relief of rectal hemorrhage was 74.3%(26/35) and 20.0%(7/35), the complete and partial relief of intestinal obstruction was 55.0%(11/20) and 35.0%(7/20), respectively. The overall symptom complete response was 21.6%, and the partial response was 43.1%. The side effects of pelvic radiotherapy were slight. The median effective duration of pain, hemorrhage, and obstruction were 6.5 months, 8.9 months, and 3.8 months, respectively. Five patients with initial unresectable and 8 patients with potentially resectable advanced stage underwent radical surgical resection. One patient with an initial obstruction score of 2 points underwent enterostomy after 5.5 months of radiotherapy. The overall 1-year, 2-year, and 3-year survival rates were 86.3%(44/51), 62.7%(32/51)and 45.1%(23/51), respectively. Conclusion The short-course radiotherapy of pelvic 5Gy×5F has a good palliative effect on the advanced rectal cancer. Short-course radiotherapy allows most patients with intestinal obstruction to avoid surgery, improves the radical operation rate of advanced rectal cancer. It has important significance for the transformation treatment of advanced rectal cancer.
- Advanced rectal cancer /
- Short-course palliative radiotherapy /
- Pain /
- Bleeding /
- Intestinal obstruction

HTML全文

表 1 51例晚期直肠癌患者一般资料

项目		例(%)
性别	男性	28(54.9)
	女性	23(45.1)
ECOG评分(分)	1	10(19.6)
	2	33(64.7)
	3	8(15.7)
肿瘤距肛缘距离(cm)	6~12	15(29.4)
	≤5	36(70.6)
直肠分期	T3MRF-	11(21.6)
	T3MRF+	23(45.1)
	T4MRF+	17(33.3)
	N-	8(15.7)
	N+	43(84.3)
转移部位	肝转移	31(60.8)
	肝肺转移	5(9.8)
	肺转移	11(21.6)
	后腹膜转移	4(7.8)

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表 2 51例晚期直肠癌患者放疗前后症状评分[例(%)]

项目		0分	1分	2分	3分
放疗前	疼痛	17(33.3)	15(29.4)	13(25.5)	6(11.8)
	出血	16(31.4)	21(41.2)	12(23.5)	2(3.9)
	梗阻	31(60.8)	18(35.3)	2(3.9)	0
放疗4周后	疼痛	38(74.5)	10(19.6)	3(5.9)	0
	出血	42(82.4)	7(13.7)	2(3.9)	0
	梗阻	42(82.4)	9(17.6)	0	0

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表 3 51例晚期直肠癌患者放疗毒副反应评估[例(%)]

内容	0级	1级	2级	3级	4级
恶心/呕吐	48(94.1)	2(3.9)	1(2.0)	0	0
腹泻	39(76.5)	8(15.7)	4(7.8)	0	0
放射性皮炎	46(90.2)	3(5.9)	2(3.9)	0	0
放射性膀胱炎	43(84.3)	4(7.8)	3(5.9)	1(2.0)	0
中性粒细胞下降	33(64.7)	11(21.6)	5(9.8)	2(3.9)	0
贫血	36(70.6)	10(19.6)	3(5.9)	2(3.9)	0
血小板下降	37(72.5)	11(21.6)	2(3.9)	1(2.0)	0
总胆红素升高	45(88.2)	3(5.9)	2(3.9)	1(2.0)	0
谷丙转氨酶升高	34(66.7)	12(23.5)	3(5.9)	2(3.9)	0
谷草转氨酶升高	33(64.7)	15(29.4)	2(3.9)	1(2.0)	0

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