临床肿瘤学杂志 ›› 2018, Vol. 23 ›› Issue (5): 463-466.

• 综述与讲座 • 上一篇    下一篇

放疗在同步转移直肠癌中的应用价值

  

  1. 100700  北京  中国人民解放军陆军总医院放疗科
  • 收稿日期:2017-12-13 修回日期:2018-03-02 出版日期:2018-05-31 发布日期:2018-06-07

The role of radiotherapy in the management of rectal cancer with synchronous metastases

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  1. Department of Radiation Oncology, General Hospital of PLA Army, Beijing 100700, China
  • Received:2017-12-13 Revised:2018-03-02 Online:2018-05-31 Published:2018-06-07

摘要: 同步转移直肠癌占新诊断直肠癌的16%~20%,肿瘤负荷较低时,原发灶及转移灶均可切除,术前或术后局部放疗能提高局部控制率,2年局部复发率仅为0~11%,但远处转移仍为主要失败模式(2年远处转移率为56%~75%),放疗未能提高总生存率(2年生存率为65%~80%)。对于肿瘤负荷高的患者,原发灶及转移灶既不能手术切除也不能通过射频消融、介入等手段消除,盆腔局部放疗能使80%~85%患者的症状(梗阻、出血、疼痛)获得长期缓解,免去造瘘的不便。5×5 Gy的短程放疗具有治疗时间短、副反应小、疗效不低于常规长程放疗、尤其不会使手术或系统化疗延期等优势,应作为同步转移Ⅳ期直肠癌首选放疗方式。

关键词: 直肠癌, 同步转移, 放射治疗

Abstract: Synchronous metastasis of rectal cancer accounts for 16%-20% of newly diagnosed rectal cancer. Of these patients with lower tumor burden received simultaneous or staged radical resection in both primary and metastases tumor could prolong overall survival. For these patients, pre-or post-operative pelvic radiotherapy improved locoregional control and the 2-year local recurrent rate was only 0-11%, but the majority (56%-75%) of recurrences occurred in distant organs, and radiotherapy did not improve 2-year overall survival rate of 65%-80%. For the patients with high tumor burden, the primary and metastases tumor could not be removed through surgical resection or local-directed therapy including radiofrequency ablation or transarterial chemoembolization. Of these patients, palliative radiotherapy could relieve symptomatic respose rate (bleeding, pain or obstruction) in 80%-85% patients and last for a long term avoiding unnecessary colostomy. Short course radiotherapy of 5×5 Gy, which had advantages including short treatment time, lower toxicities, similar efficacy as long course radiotherapy and without delay of surgery or systemic chemotherapy should be the optimal radiation method for patients with synchronous metastases rectal cancer.

Key words: Rectal cancer, Synchronous metastases, Radiotherapy

中图分类号: 

  • R735.3+7
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