摘要
AIM： To investigate the effect of three-dimensional conformal radiotherapy （3-DCRT） in combination with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer. METHODS： Forty-eight patients with unresectable recurrent rectal cancer were randomized and treated by 3-DCRT or 3-DCRT combined with FOLFOX4 chemotherapy between September 2001 and October 2003. For the patients without prior radiation history, the initial radiation was given to the whole pelvis by traditional methods with tumor dose of 40 Gy, followed by 3-DCRT for the recurrent lesions to the median total cumulative tumor dose of 60 Gy （range 56-66 Gy）; for the post-radiation recurrent patients, 3-DCRT was directly given for the recurrent lesions to the median tumor dose of 40 Gy （36-46 Gy）. For patients in the study group, two cycles chemotherapy with FOLFOX4 regimen were given concurrently with radiotherapy, with the first cycle given simultaneously with the initiation of radiation and the second cycle given in the fifth week for patients receiving conventional pelvis radiation or given in the last week of 3-DCRT for patients receiving 3-DCRT directly. Another 2-4 cycles （average 3.6 cycles） sequential FOLFOX4 regimen chemotherapy were given to the patients in the study group, beginning at 2-3 wk after chemoradiation. The outcomes of symptoms relieve, tumor response, survival and toxicity were recorded and compared between the study group and the control group. RESULTS： For the study group and the control group, the pain-alleviation rates were 95.2% and 91.3%（P〉 0.05）; the overall response rates were 56.5% and 40.0% （P〉0.05）; the 1-year and 2-year survival rates were 86.9%, 50.2% and 80.0%, 23.9%, with median survival time of 25 mo and 16 mo （P〈 0.05）; the 2-year distant metastasis rates were 39.1% and 56.0% （P= 0.054）, respectively. The side effects, except peripheral neuropathy which was relatively severer in the study group, were similar in the the two groups and well tolerated. CONCLUSION： Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer is a feasible and effective therapeutic approach, and can reduce distant metastasis rate and improve the survival rate.
瞄准：为 unresectable 与 FOLFOX4 化疗在联合调查三维的保角的放射疗法(3-DCRT ) 的效果周期性的直肠的癌症。方法：有 unresectable 的 48 个病人周期性的直肠的癌症被与在 2001 年 9 月和 2003 年 10 月之间的 FOLFOX4 化疗相结合的 3-DCRT 或 3-DCRT 使随机化并且对待。为没有优先的放射历史的病人，起始的放射被传统的方法与 40 Gy 的肿瘤剂量给整个骨盆，为周期性的损害由 3-DCRT 列在后面到 60 Gy (范围 56-66 Gy ) 的中部的全部的累积肿瘤剂量；为放射以后的周期性的病人， 3-DCRT 直接为周期性的损害被给 40 Gy (36-46 Gy ) 的中部的肿瘤剂量。为在学习组的病人，有 FOLFOX4 政体的二周期化疗与放射疗法并发地被给，为收到常规骨盆放射的病人交上第五个星期，第一个周期和第二个周期与放射的开始同时给或为直接收到 3-DCRT 的病人交上 3-DCRT 的最后星期。顺序的 FOLFOX4 政体化疗在学习被给病人的另外一个 2-4 周期(一般水准 3.6 周期) 组织，在在 chemoradiation 以后的 2-3 wk 开始。症状 relieve，肿瘤反应，幸存和毒性的结果在学习组和控制组之间被记录并且比较。结果：为学习组和控制组，疼痛缓和率是 95.2% 和 91.3%(P > 0.05 ) ；全面反应率是 56.5% 和 40.0%(P > 0.05 ) ；1 年、 2 年的幸存率是 86.9% ， 50.2% 和 80.0% ， 23.9% ，与 25 瞬间和 16 瞬间的中部的生存时间(P < 0.05 ) ；2 年的远转移率是 39.1% 和 56.0%(P = 0.054 ) 分别地。副作用，除了是的外部神经病，相对，在学习的 severer 组织，是类似的在二个组和井容忍了。结论：三维的保角的放射疗法为周期性的直肠的癌症是的 unresectable 与 FOLFOX4 化疗结合了一条可行、有效的治疗学的途径，和罐头减少远转移率并且改进幸存率。
