摘要目的 评价直肠癌术前改良短程放化疗与常规分割放化疗疗效和安全性.方法 60例可切除直肠癌患者随机分成术前改良短程放化疗(A组,30例,30 Gy分10次)和常规分割放化疗(B组,30例,45 Gy分25次),分别在放化疗后2周和6～8周手术.结果 A组和B组病理降期率分别为30％和67％ (P=0.004)、保肛率分别为53％和68％(P=0.291)、R0切除率分别为97％和100％(P=0.236)、3年OS率分别为83％和88％(P=0.717)、3年局部复发率分别为10％和7％(P=0.639)、3年远地转移率分别为27％和30％(P=0.774).两组中有降期及无降期患者3年OS率分别为97％及74％(P=0.016);A组1-3级放射性皮炎、2级放射性肠炎、2级白细胞减少发生率、吻合口瘘及伤口延期愈合率与B组相近(P=0.092～0.717).结论 术前改良短程放化疗及常规分割放化疗均可作为可切除直肠癌术前新辅助放化疗选择方案,且术前改良短程放化疗有治疗周期短、住院时间短、费用低、患者易接受等优势.

abstractsObjective To investigate the efficacy and safety of preoperative modified short-course chemoradiotherapy and conventionally fractionated chemoradiotherapy for rectal cancer.Methods A total of 60 patients with resectable rectal cancer were randomized into preoperative modified short-course chemoradiotherapy group (group A,30 patients,30 Gy in 10 fractions) and conventionally fractionated chemoradiotherapy group (group B,30 patients,45 Gy in 25 fractions),and surgery was performed at 2 weeks and 6-8 weeks after chemoradiotherapy,respectively.Results Group A and group B had pathologic downstaging rates of 30％ and 67％ (P=0.004),sphincter preservation rates of 53％ and 68％ (P=0.291),RO resection rates of 97％ and 100％ (P=0.236),3-year overall survival rates of 83％ and 88％ (P=0.717),3-year locoregional recurrence rates of 10％ and 7％ (P=0.639),and 3-year distant metastasis rates of 27％ and 30％ (P=0.774).In these two groups,the patients with or without the downstaging phenomenon had a 3-year overall survival rate of 97％ or 74％ (P =0.016).The incidence rates of grade 1-3 radiodermatitis,grade 2 radiation enteritis,and grade 2 leucopenia,anastomotic leak,and delayed wound healing were similar between the two groups (P=0.092-0.717).Conclusions Both preoperative modified short-course chemoradiotherapy and conventionally fractionated chemoradiotherapy can be used as the regimen of preoperative neoadjuvant chemoradiotherapy in patients with resectable rectal cancer,and preoperative modified short-course chemoradiotherapy has a short treatment cycle,a short time of hospital stay,and a low cost,and is easily accepted by patients.