直肠癌术后VMAT同期化疗与IMRT同期化疗的急性不良反应比较[摘要]目的比?^直肠癌术后容积调强弧形治疗（VMAT）同期化疗与调强放射治疗（IMRT）同期化疗的急性不良反应，探讨VMAT同期化疗的临床应用价值。方法选取2010年7月～2017年1月于梅州市人民医院就诊的50例局部进展期直肠癌患者（T2～T4或N+）作为研究对象。根据不同的治疗方式，将其分为VMAT组（n=20例）和IMRT组（n=30例）。其中VMAT组患者采用VMAT联合卡培他滨同期化疗，IMRT组患者采用IMRT联合卡培他滨同期化疗，两组同期化疗方案均为卡培他滨825mg/m2，2次/d，5次/周。辅助化疗为8～10次改良FOLFOX6方案。比较两组患者治疗期间皮肤黏膜、消化道、泌尿系及血液系统等急性不良反应的发生情况。结果VMAT组患者均完成放疗，IMRT组有3例患者因不能耐受不良反应终止放疗。两组患者中急性不良反应最常见的依次是下消化道反应、皮肤黏膜反应及上消化道反应；IMRT组Ⅱ～Ⅳ级下消化道发生率显著高于VMAT组（P<0.05）；两组皮肤黏膜反应、泌尿系反应、上消化道反应及白细胞减少、血小板下降、贫血等骨髓抑制反应比较，差异无统计学意义（P>0.05）。结论直肠癌术后VMAT联合卡培他滨同期化疗急性不良反应发生率较低，与IMRT联合卡培他滨同期化疗相比能显著减少严重的下消化道反应，治疗耐受性好。[关键词]直肠癌；容积旋转调强放疗；三维适形调强放疗；卡培他滨；急性不良反应[]R739.63[文献标识码]A[]1674-4721（2017）04（b）-0071-05ComparisonoftheacuteadversereactionsofsameperiodchemotherapyofVMATandIMRTaftercolorectalcancersurgeryLUO激ngLIGuo-qiangZHENGZhi-激anYELingXUYu-yunLIUYa-shengYANGQuan-fuDepartmentofRadiotherapy，MeizhouPeople′sHospitalofGuangdongProvince，Meizhou514031，China[Abstract]ObjectiveTocomparetheacuteadversereactionsofsameperiodchemotherapyofVMATandIMRTaftercolorectalcancersurgery，andtoexploretheclinicalapplicationvalueofthesameperiodVMATchemotherapy.Methods50patientswithlocallyadvancedrectalcancer（stageT2-T4orN+）fromJuly2010toJanuary2017inMeizhouPeople′sHospitalwereselectedastheresearchobject，accordingtothedifferentwaysoftreatment，theyweredividedintoVMATgroup（n=20）andIMRTgroup（n=30）.PatientsoftheVMATgroupweregiventhetreatmentofVMATcombinedwithCapecitabineatthesameperiod，patientsoftheIMRTgroupweregiventhetreatmentofIMRTcombinedwithCapecitabineatthesameperiod.ThesamechemotherapyregimensofCapecitabinewas825mg/m2，2perday，5perweek.Adjuvantchemotherapyfor8-10ofimprovedFOLFOX6scheme.Acuteadversereactionsofpatientsoftwogroupsduringtreatment，suchasskinmucousmembrane，digestivetract，urinarytractandhematologicsystemwerecompared.ResultsAllpatientsoftheVMATgroupcompletedtheoperation，and3casesoftheIMRTgroupcouldnottoleratetheadversereactionsandterminatedtheradiation.Themostcommonadversereactionsofpatientsinthetwogroupsweredigestivetract，uppergastrointestinaltract，skinandmucosareactionandresponseinsequence；theincidenceoflevelsⅡ-ⅣdigestivetractintheIMRTgroupwassignificantlyhigherthanthatofVMATgroup（P<0.05）.Inthetwogroupsinthereactionofskinmucousmembrane，urinarysystem，uppergastrointestinaltract，andbonemarrowsuppressionsuchasleukopenia，decreasedplateletandanemiahadnosignificantdifference（P>0.05）.ConclusionPostoperativerectalcancersameperiodchemotherapyofVMATcombinedwithCapecitabinehasalowerincidenceofacuteadversereactions，comparedwithIMRTcombinedwithCapecitabinecansignificantlyreducetheseveregastrointestinalreaction，andwithgoodtolerance.[Keywords]Rectalcancer；VMAT；IMRT；Capecitabine；Acuteadversereactions手术切除是直肠癌的首选治疗方法，但单纯手术治疗后局部复发率较高，研究表明，术后放疗能显著...