汉防己甲素配合放疗治疗局部晚期和复发直肠癌的临床研究
[摘要] 目的探讨汉防己甲素(Tetrandrine,Tet)对局部晚期和复发直肠癌放疗增敏作用及其不良反应。方法回顾性分析2000年至2005年收治的局部晚期和复发直肠癌33例患者的临床资料，其中15例给予单纯放疗(放疗组),18例放疗的同时给予Tet(Tet组)。放疗采用15MVX线常规分割照射，病灶总量达60-66Gy/30~33F/6~7周。Tet组在照射第1天开始服用Tet，每次40mg，3次·d-1，直至放疗结束。结果两组患者局部症状缓解率均为100%,症状缓解开始的中位时间Tet组较放疗组短，但差异无统计学意义(P>0.05)。Tet组和放疗组便血和疼痛症状缓解持续的中位时间分别为15个月和8个月，具有统计学差异（P＜0.05）；近期有效率分别为72.2%和64.3%,1、2、3年生存率分别为77.8%、44.4%、27.8%和64.3%、33.3%、20.0%,两组比较无统计学差异(P>0.05)。结论Tet配合放疗，能有效延长局部晚期和复发直肠癌局部症状缓解持续时间，生存率有提高趋势，可能是一种理想的放射增敏剂。
[关键词] 汉防己甲素；放射治疗；直肠癌
Radiotherapy with Tetrandrine for locally advanced
and recurrent rectal cancer
CAO Yuan-dong 1,SUN Xin-chen 1,CHENG Hong-yan 1,YU Da-hai 2, GE Xiao-lin 1,LI Yi-kun 1,XUE You-hua 1,LIN Qian 1,MA Chun-yang 1
(1.Department of Oncology,Zhongda Hospital，Southeast University,Nanjing 210009,China;
2.Department of Radiotherapy,Xuzhou Hospital Affiliated to Medical College of Southeast University,Xuzhou 221009,China)
Abstract:Objective To study the effect of radiotherapy combined with Tetrandrine(Tet)in the treatment of locally advanced and recurrent rectal cancer.Methods The data of 33 cases of locally advanced and recurrent rectal cancer from 2000 to 2005 were analysed retrospectively,of which 15 patients received radiotherapy(radiotherapy group),18 cases received radiotherapy combined with Tet(Tet group).All patients were treated with conventional radiotherapy by 15MVX ray to a total dose of 60-66Gy in 6-7 weeks for the respectable disease.During radiotherapy of the Tet group ,all the patients took Tet 40mg every time and three
times per day.ResultsLocal symptom remission rate was 100% for the two groups.Symptoms remission beginning time of the Tet group was shorter than the radiotherapy group，but had no statistical difference(P>0.05).Hematochezia and pain relief sustained median time of the Tet group and the radiotherapy group were 15 months and 8 months,and there was a significant difference between the two groups(P ＜0.05).Effective power of the Tet group and the radiotherapy group were 72.2% and 64.3%,there was no significant difference(P>0.05).1,2,3-year survival rates of the Tet group and the radiotherapy group were 77.8%,44.4%,27.8% and 64.3%,33.3%,20.0%,there was no significant difference(P>0.05).Conclusion Tet with radiotherapy can effectively extend locally symptom remission time for advanced and recurrent rectal cancer,and survival rate have a trend of improvement.Tet may be an ideal radiosensitizer.
Key words:Tetrandrine;radiotherapy;rectal cancer
(Modern Medical Journal,2008,36:97-100)
汉防己甲素(Tetrandrine,Tet),又称粉防己碱、汉防己碱,主要存在于千金藤属植物粉防己的根中,是一种具有广泛药理作用的双苄基异喹啉类生物碱。许多基础研究[1-3]证明，Tet可抑制癌细胞的生长，具有抗肿瘤作用，并且对细胞周期具有调控作用。临床研究[4]已经证实肺癌放疗中，Tet是一种理想的增敏剂。对
于直肠癌，基础实验[5]已证实Tet可使结肠癌HT29细胞G 2~M期明显增加,S
期细胞明显减少，因此认为Tet对大肠癌放疗可起到增敏作用。本研究回顾性地分析了2000年至2005年经治的33例局部晚期和复发直肠癌患者的临床资料，现报告如下。
1 资料与方法
1.1一般资料
2000年9月至2005年5月收治的局部晚期或术后复发的直肠癌患者共33例，其中男21例,女12例，年龄34~78岁，中位年龄53岁。所有患者盆腔CT 发现直肠可测量病变，并经肠镜检查病理确诊，胸腹部CT排除远处转移。病理诊断腺癌26例,黏液腺癌6例,印戒细胞癌1例，Karnofsky评分≥50分。单纯放疗15例,设为放疗组,放疗加Tet 18例,设为Tet组，两组一般情况见表1。在治疗前，Tet组和放疗组中存在腰骶部或会阴部疼痛者分别为15例和12例，便血及肛门下坠感分别为11例和10例。
1.2治疗方法
所有患者照射方法均采用俯卧位两侧野和后野三野等中心照射,两侧野加用
