氟尿嘧啶栓联合放疗治疗老年局部晚期直肠癌的临床观察(1)
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【摘要】 目的 观察氟尿嘧啶栓联合放疗治疗老年局部晚期不可手术直肠癌的疗效和不良反应。方法 46例经病理证实的老年局部晚期不可手术的直肠癌患者接受氟尿嘧啶栓塞肛,200 mg/粒,2次/d,连用10 d。24 d为一周期,共用2个周期。同期接受盆腔三维适形放疗,46~50 Gy/23~25F,后缩野至肿瘤区继续推量至64~66 Gy/32~33F,如有残留病灶则行腔内放疗15~20 Gy。结果 CR 18例(39.1%),PR 23例(50.0%),SD5例(10.9%),总有效率(CR+PR)89.1%,中位生存时间21.6个月,1、2年生存率分别为87.4%、71.9%。治疗相关毒副作用主要是腹泻和中性粒细胞减少,经对症处理患者均能耐受。结论 氟尿嘧啶栓联合放疗治疗老年局部晚期不可手术的直肠癌安全、有效,值得临床进一步研究。
【关键词】局部晚期;直肠癌;氟尿嘧啶栓;放疗
Fluorouracil suppository and concurrent radiotherapy in elderly local advanced rectal cancer
LI Ying,DAI Hong-wei,SUN Yu-xin,et al.Department of Radiation Oncology,the Second People’s Hospital of Liaocheng City.Shandong 252600,China
【Abstract】 Objective To observe the effect and toxicity of fluorouracil suppository and concurrent radiotherapy in elderly local advanced rectal cancer.Methods Forty-six elderly patients with ocal advanced rectal cancer were treated with 200 mg fluorouracil suppository by rectum,twice a day,for 10 days,a 24-dat cases of treatment, two cases of the treatment and combination with three dimensional-conformal radiotherapy(for46~50 Gy/23~25F and was boosted to the tumor 16~18Gy/2 weeks,2Gy/fraction,5 days/week).Intra-rectal cavity radiotherapy with 15~20 Gy for the residual lesion.Results The overall response rate was 89.1%,with CR 18 cases(39.1%),PR 23cases(50.0%),SD 5cases(10.9%).Median survival time,the 1、2a survival rate were 21.6 months,87.4%、71.9% respectively.Treatment-related toxicity mainly showed at diarrhea and neutrocytopenia.Conclusion Fluorouracil suppository and concurrent radiotherapy in elderly local advanced rectal cancer is safty,effective and valuable clincial study.
【Key words】
Locally advanced; Rectal cancer; Fluorouracil suppository; Radiotherapy
同期放化疗加手术治疗是局部晚期直肠癌的主要治疗手段,化疗药物仍然以氟尿嘧啶为主。然而老年晚期患者由于身体条件差、合并症多,确诊时往往失去手术机会,同时由于老年人脏器功能减退,难以耐受全身化疗带来的副作用。本研究采用氟尿嘧啶栓直肠局部给药联合体内外放疗对这部分患者进行治疗,现将结果报告如下。
1 资料与方法
1.1 一般资料 2003年2月至2008年3月聊城市二院和山东省肿瘤医院放疗科收治的老年局部晚期不能活拒绝手术的直肠癌初治患者46例,男29例,女17例,年龄70~87岁,所有患者均经直肠镜检查并活检取得病理证实,病理类型:高分化腺癌3例,中分化腺癌16例,低分化腺癌20例,黏液腺癌例7例。临床分期为T3~T4期,经B超、CT、胸片等检查均无远地转移,所有患者均有可测量病灶,KPS评分均≥70分,血常规及肝、肾功能正常 ......
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