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[目的]观察VMAT联合XELOX方案术前治疗局部晚期直肠腺癌的早期临床疗效及治疗不良反应,明确其在临床实践中的可行性。[方法]入组2012年3月至2014年9月符合入组条件的局部进展期直肠腺癌患者86例,予以术前放化疗。全组放疗采用VMAT技术,靶区剂量为:计划大体肿瘤靶体积(PGTV):50Gy/25次,计划靶区(PTV):45Gy/25次,1次/d,5次/周。同步化疗采用XELOX方案,具体如下:卡培他滨1600mg/m2/d,分两次口服,d1~14,22~25,奥沙利铂100mg/m2,d1,22)。术后继续行XELOX方案化疗4个周期。[结果 ]全组86例患者均完成放疗。放化疗期间3~4级急性不良反应发生情况:血液学毒性:3~4级白细胞减少5例(5.8%);3~4级血小板减少2例(2.3%)。非血液学毒性:3~4级腹泻13例(15.1%)。全组共85例患者完成手术,其中Dixon手术57例,Miles’手术26例,Hartmann手术1例,其他1例。低位直肠癌保肛率为50%(23/46)。82例(96.5%)患者R0切除。全组病理完全缓解率(p CR)20.0%(17/85)。局部T分期、N分期及临床分期降期率分别为82.4%、52.9%和76.5%。术后60天内无死亡病例。[结论]VMAT联合XELOX方案术前治疗局部进展期直肠腺癌可获得良好的p CR率及肿瘤降期率,不良反应可耐受,值得临床推广。
[Objective] To observe the early clinical efficacy and adverse reactions of VMAT combined with XELOX regimen in the treatment of locally advanced rectal adenocarcinoma and to clarify its feasibility in clinical practice. [Methods] 86 patients with locally advanced rectal adenocarcinoma who met the inclusion criteria from March 2012 to September 2014 were enrolled in this study. The whole group radiotherapy using VMAT technology, the target dose: planned gross tumor target volume (PGTV): 50Gy / 25 times, the planned target area (PTV): 45Gy / 25 times, 1 time / d, 5 times / week. Synchronous chemotherapy using XELOX program, as follows: Capecitabine 1600mg / m2 / d, orally twice, d1 ~ 14,22 ~ 25, oxaliplatin 100mg / m2, d1,22). After surgery continue XELOX chemotherapy 4 cycles. [Results] The whole group of 86 patients completed radiotherapy. Grade 3 or 4 acute adverse reactions during radiotherapy and chemotherapy: Hematologic toxicities: Grade 3 to 4 leukopenia in 5 (5.8%); grade 3 to 4 thrombocytopenia in 2 (2.3%). Non-hematologic toxicity: Grade 3 to 4 diarrhea in 13 cases (15.1%). The whole group of 85 patients completed the operation, including 57 cases of Dixon operation, Miles’ surgery in 26 cases, Hartmann operation in 1 case, the other 1 case. Low rectal cancer anal sphincter rate was 50% (23/46). 82 cases (96.5%) patients R0 resection. The complete pathological complete remission rate (p CR) 20.0% (17/85). Local T staging, N staging and clinical staging were 82.4%, 52.9% and 76.5%, respectively. No deaths within 60 days after surgery. [Conclusion] VMAT combined with XELOX regimen in preoperative treatment of locally advanced rectal adenocarcinoma can obtain good pCR rate and tumor reduction rate, adverse reactions are tolerable, worthy of clinical promotion.