改良放化疗治疗上、中壶腹直肠癌的新方法

Y. Gevorkyan, N. Soldatkina, M. N. Chernyak, M. Gusareva, O. Bondarenko, E. Dzhenkova, A. Dashkov, V. E. Kolesnikov, D. Petrov, R. E. Tolmakh, D. A. Savchenko
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引用次数: 0

摘要

过去十年的特点是手术前直肠癌治疗取得了重大进展(使用长期放射治疗将复发率降低至5 - 6%)。直肠下壶腹癌的治疗取得了最大的成功,此时直肠肿瘤对放化疗有了完全的临床反应。然而,提高上壶腹和中壶腹直肠癌的治疗效果,提高患者的生存率仍然是需要解决的问题。这就需要开发新的方法,提高直肠癌治疗的有效性。本研究提出改良放化疗治疗直肠上壶腹癌的方法。方法如下:第一阶段,放疗开始前1天,患者经桡动脉或股动脉超选择性置管直肠上动脉,局部给予化疗药物顺铂50 mg、氟尿嘧啶500 mg。在一天内,患者开始接受一个疗程的适形远程大剂量放射治疗,以主要病灶和转移途径为5个疗程,单局剂量为5 Gy至总局剂量为25 Gy,使用低能线性加速器。在整个放射治疗过程中,在放射治疗前30分钟内每日静脉注射氟尿嘧啶500毫克,持续30分钟。在放射治疗完成后6-8周进行手术干预,并取样研究材料。为了评估改良放化疗的有效性,根据RECIST量表确定肿瘤消退的分期,并根据Dworak对术中切除的直肠肿瘤进行形态学研究,确定肿瘤的治疗病理形态学水平。所开发的改良放化疗方法可以在短时间内实现直肠肿瘤的消退,减少了治疗时间,提高了治疗效果。改良放化疗方法适用于壶腹上、中端直肠癌T3-4N0-2M0患者,第一阶段采用放疗,然后在标准体积内行直肠切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
New method of modified chemoradiotherapy for cancer of the upper and middle ampullary rectum
The last decade is characterized by significant progress in the treatment of rectal cancer (reduction in the number of relapses to 5–6 % with the use of prolonged radiation therapy) before surgery. The greatest success has been achieved in the treatment of cancer of the lower ampulla of the rectum, when it is possible to develop a complete clinical response of the rectal tumor to chemoradiotherapy. Nevertheless, the requirement issues to improve the results of treatment of cancer of the upper and middle ampullar rectum with an increase in the survival of patients remain. Which makes it relevant to develop new methods, that increase the effectiveness of the treatment of rectal cancer.The method of modified chemoradiotherapy for cancer of the upper ampulla of the rectum was developed in our study. The method is as follows: at the first stage, one day before the start of radiation therapy, the patient undergoes superselective catheterization of the superior rectal artery through the radial or femoral artery, followed by regional administration of radiomodifying chemotherapy drugs: cisplatin 50 mg and fluorouracil 500 mg. In one day, patients begin to undergo a course of conformal remote large- fraction radiation therapy to the primary focus and metastasis pathways for 5 sessions with a single focal dose of 5 Gy to a total focal dose of 25 Gy using a low-energy linear accelerator. During the entire course of radiation therapy, fluorouracil 500 mg is administered daily intravenously for 30 minutes in 30 minutes before the session. Surgical intervention with the sampling of material for research is carried out 6–8 weeks after the radiation therapy is completed. To assess the effectiveness of the modified chemoradiotherapy, the stage of tumor regression was determined according to the RECIST scale, and the level of therapeutic pathomorphology of the tumor according to Dworak was determined during a morphological study of the rectal tumor removed during the operation.The developed method of modified chemoradiotherapy makes it possible to achieve regression of the rectal tumor in a short time, reduce the time and increase the effectiveness of treatment. The method of modified chemoradiotherapy is intended for patients with cancer of the upper and middle ampullar rectum T3-4N0-2M0, for whom radiation therapy is indicated as the first stage of treatment, after which resection of the rectum is performed in a standard volume.
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