Rápolti Edit, Szigeti András, Farkas Róbert, Bellyei Szabolcs, Boronkai Arpád, Papp András, Gömöri Eva, Horváth Ors Péter, Mangel László
Pécsi Tudományegyetem Onkoterápiás Intézet 7623 Pécs Ifjúság út 13.
Magy Onkol. 2009 Dec;53(4):345-9. doi: 10.1556/MOnkol.53.2009.4.3.
We investigated the response rate and side effects of simultaneous, neoadjuvant radiochemotherapy (RCT) in locally advanced rectal cancer. Between 2005 and 2007, we treated 112 patients in stage II-III rectal carcinoma at the Institute of Oncotherapy, University of Pécs. For staging abdomino-pelvic CT (112) and transrectal US (49) or pelvic MR (10), or PET-CT (1) was performed. Radiation therapy was delivered with 3D CRT-based technique using belly-board with 18 MV photon energy, while patients in prone position. A total dose of 45 Gy (single dose 1.8 Gy) was delivered to the tumor and the pelvic lymph nodes. 5-FU and Ca-folinate was administered concomitantly in the 1st and 5th week of radiotherapy. Four weeks after delivering neoadjuvant RCT the patients' control CT was evaluated according to RECIST criteria. RCT was followed by surgery in 6-9 weeks. We graded the histology using the Mandard regression score system. Side effects were registered using CTCAE v 3.0. Grade 1, 2 or 3 acute gastrointestinal toxicity occurred in 12%, grade 3 hematological toxicity in 9.5% of the patients. The response rate determined by using control CT was 64.85%. According to the Mandard regression score, TRG1 occurred in 15%, TRG2 in 30.4%, TRG3 in 28%, TRG4 in 24% and TRG5 in 2.6% of the cases. Radical surgery was performed in 89 cases, 72 with R0 resection. By assessing the histological samples we found downstaging in 46% of the T and 34.5% of the N stage. We have no information on increased postoperative complications. We followed 86 patients after neoadjuvant therapy. Until March 2009 there was no progression in 48 of our patients. In 13 cases local relapse occurred, and in 25 cases the disease progressed because of distant metastasis, although local control was maintained. 10 patients had local relapse and distant metastases. 17 patients passed away. As a conclusion, neoadjuvant RCT of Stage II-III patients is an effective and well tolerated treatment, allowing for high R0 resection rate and bearing no higher risk for postoperative morbidity.
我们研究了同步新辅助放化疗（RCT）在局部晚期直肠癌中的缓解率和副作用。2005年至2007年期间，我们在佩奇大学肿瘤治疗研究所对112例II - III期直肠癌患者进行了治疗。为进行分期，进行了腹部盆腔CT（112例）、经直肠超声（49例）或盆腔磁共振成像（10例），或正电子发射断层显像 - CT（1例）检查。放射治疗采用基于三维适形放疗（3D CRT）的技术，使用腹托板，光子能量为18兆电子伏特，患者取俯卧位。肿瘤及盆腔淋巴结接受的总剂量为45 Gy（单次剂量1.8 Gy）。在放疗的第1周和第5周同时给予5 - 氟尿嘧啶和亚叶酸钙。在给予新辅助RCT四周后，根据实体瘤疗效评价标准（RECIST）评估患者的对照CT。新辅助RCT后6 - 9周进行手术。我们使用曼德尔回归评分系统对组织学进行分级。使用美国国立癌症研究所常见不良反应事件评价标准（CTCAE）v 3.0记录副作用。12%的患者发生1级、2级或3级急性胃肠道毒性，9.5%的患者发生3级血液学毒性。通过对照CT确定的缓解率为64.85%。根据曼德尔回归评分，TRG1在15%的病例中出现，TRG2在30.4%的病例中出现，TRG3在28%的病例中出现，TRG4在24%的病例中出现，TRG5在2.6%的病例中出现。89例患者进行了根治性手术，72例实现了R0切除。通过评估组织学样本，我们发现46%的T分期和34.5%的N分期出现降期。我们没有关于术后并发症增加的信息。新辅助治疗后我们对86例患者进行了随访。截至2009年3月，我们的48例患者无病情进展。13例发生局部复发，25例因远处转移病情进展，尽管保持了局部控制。10例患者发生局部复发和远处转移。17例患者死亡。结论是，II - III期患者的新辅助RCT是一种有效且耐受性良好的治疗方法，可实现高R0切除率，且术后发病风险不会更高。
