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目的 探讨容积调强弧形放疗(VMAT)联合Xelox化疗方案(卡培他滨加奥沙利铂)用于局部进展期直肠癌新辅助治疗的可行性.方法 回顾性分析2011年4月至2013年4月中山大学肿瘤防治中心放射治疗科术前予以Xelox化疗方案同期联合VMAT的141例局部进展期直肠癌患者的临床资料,男95例、女46例,中位年龄56岁;临床分期:Ⅱa期18例、Ⅱb期11例、Ⅱc期4例、Ⅲa期1例、Ⅲb期52例、Ⅲc期55例.全组放疗采用单弧VMAT技术,靶区剂量PTV1:50 Gy/25次,PTV2:46 Gy/23次,1次/d,5次/周.放疗期间,全组均行Xelox方案同期化疗.结果 全组141例患者均完成放疗计划,2例(1.4％)因3级腹泻中断放疗.放化疗期间,全组累计3级血液学及非血液学不良反应发生率分别为9.9％和16.3％,无4级不良反应.患者距放疗结束后中位时间54(34～86)d进行手术.手术R0切除率100％,低位直肠癌保肛率45.8％(33/72);术后并发症发生率17.0％(24/141);术后病理完全缓解(pCR)率32.6％(46/141),原发肿瘤T分期、N分期及TNM分期的降期率分别为87.2％(123/141)、88.0％(95/108)和90.1％(127/141).结论 VMAT联合Xelox方案化疗应用于局部进展期直肠癌新辅助治疗安全可行,可获得较高pCR率及肿瘤降期率,且耐受性佳.

Objective To investigate the feasibility of Xelox (capecitabine plus oxaliplatin) in the volumetric modulated arc therapy (VMAT)-based preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC).Methods Clinical data of 141 LARC patients in our hospital from April 2011 to April 2013 treated by preoperative CRT based on VMAT with concurrent Xelox followed by surgery were analyzed retrospectively.There were 95 men and 46 women,and the median age was 56 years old.Clinical staging was stage Ⅱ in 33 cases (18 cases with Ⅱa,11 cases with Ⅱb,4 cases with Ⅱc) and stage Ⅲ in 108 cases (1 case with Ⅲa,52 cases with Ⅲb,55 cases with Ⅲc).The target doses were 50 Gy for PTV1 in 25 fractions and 46 Gy for PTV2 in 23 fractions.Results All the patients completed the planned radiotherapy,and only 2 cases were interrupted with acute grade 3 diarrhea.The overall incidence of grade 3 hematologic and non-hematologic adverse events during CRT was 9.9％ and 16.3％ respectively without grade 4 toxicity.Operation was performed after a median interval of 54 days(34-86 days) following CRT.The R0 resection rate was 100％,sphincter preservation rate for low rectal cancer was 45.8％ (33/72),postoperative complication morbidity was 17.0％ (24/141),pCR rate was 32.6％(46/141),and rates of pathological down-staging for the primary tumor,lymph node and clinical stage were 87.2％,88％ and 90.1％,respectively.Conclusions Xelox is feasible and well tolerated in the treatment of VMAT-based preoperative CRT for patients with LARC,with excellent rates of pCR and pathological down-staging.