局部中下段进展期直肠腺癌术前放化疗同步加区域热疗。

Regional hyperthermia added to intensified preoperative chemo-radiation in locally advanced adenocarcinoma of middle and lower rectum.

机构信息

Department of Radiotherapy, University Hospital, Verona.

出版信息

Int J Hyperthermia. 2010;26(2):108-17. doi: 10.3109/02656730903333958.

DOI:10.3109/02656730903333958

PMID:20146565

Abstract

PURPOSE

To evaluate the safety of delivering pre-operative regional hyperthermia (HT) plus an intensified chemo-radiotherapy (CRT) regimen in patients suffering from locally advanced rectal cancer.

METHODS

Between June 2000 and April 2006, 76 patients with locally advanced (cT3-4 N0/+) rectal adenocarcinoma were treated with HT plus CRT. HT was given once a week, to a total of five treatments, 1 to 4 h after radiotherapy (50 Gy with 2-Gy fractions for 5 weeks, plus a 10-Gy boost on the tumour bed, with the same fractionation schedule). Chemotherapy consisted in 5FU 200 mg/m(2) continuous infusion throughout the 6 weeks of irradiation and OXA 45 mg/m(2) in a weekly bolus. Surgery followed 4 to 6 weeks after the completion of HT plus CRT.

RESULTS

HT plus CRT was generally well tolerated. At pathologic examination, there was a pathologic complete response (pCR) (ypT0 ypN0) in 18 out of 76 patients (23.6%), a partial response (PR) in 34/76 ones (44.7%) and a stable disease (SD) in 20/76 (26.3%) ones; 4/76 patients (5.2%) had a progression disease (PD) (distant metastases) at the time of surgery. Good predictors of a longer disease-free survival (DFS) were in order ypN status (log-rank test: p = 0.0008), ypT status (p = 0.002) and pCR (p = 0.03).

CONCLUSION

Preoperative CRT combined with regional HT yielded acceptable toxicity. The rate of pCR was encouraging, although further studies are needed to prove the long-term efficacy of adding HT to CRT.

摘要

目的

评估局部晚期直肠癌患者接受术前区域高热（HT）加强化化疗放疗（CRT）方案的安全性。

方法

2000 年 6 月至 2006 年 4 月，76 例局部晚期（cT3-4 N0/+)直肠腺癌患者接受 HT 加 CRT 治疗。HT 每周进行一次，共进行五次治疗，在放疗后 1 至 4 小时进行，总剂量为 50 Gy，2-Gy 分次 5 周，在肿瘤床加 10 Gy 增强剂量，采用相同的分次方案。化疗包括 5FU 200 mg/m(2)持续输注，持续 6 周照射，OXA 45 mg/m(2)每周一次推注。HT 加 CRT 完成后 4 至 6 周进行手术。

结果

HT 加 CRT 通常耐受性良好。在病理检查中，76 例患者中有 18 例（23.6%）出现病理完全缓解（ypT0 ypN0），34 例（44.7%）出现部分缓解（PR），20 例（26.3%）出现稳定疾病（SD）；4 例（5.2%）患者在手术时出现进展性疾病（PD）（远处转移）。无病生存（DFS）较长的良好预测因素依次为 ypN 状态（对数秩检验：p = 0.0008）、ypT 状态（p = 0.002）和 pCR（p = 0.03）。