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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 519 -523. doi: 10.3877/cma.j.issn.2095-3224.2023.06.014

经验交流

磁共振加速器治疗局部晚期直肠癌的初步经验
马慧颖, 凡新苓, 覃仕瑞, 陈佳赟, 曹莹, 徐源, 金晶, 唐源†()   
  1. 100021　北京，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科
    100021　北京，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科；518116　深圳，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院放疗科
  • 收稿日期:2023-10-19 出版日期:2023-12-25
  • 通信作者: 唐源
  • 基金资助:
    国家自然科学基金面上项目(No. 82073352)

Magnetic resonance linac for locally advanced rectal cancer: a preliminary experience

Huiying Ma, Xinling Fan, Shirui Tan, Jiayun Chen, Ying Cao, Yuan Xu, Jing Jin, Yuan Tang†()   

  1. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
  • Received:2023-10-19 Published:2023-12-25
  • Corresponding author: Yuan Tang
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马慧颖, 凡新苓, 覃仕瑞, 陈佳赟, 曹莹, 徐源, 金晶, 唐源. 磁共振加速器治疗局部晚期直肠癌的初步经验[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 519-523.

Huiying Ma, Xinling Fan, Shirui Tan, Jiayun Chen, Ying Cao, Yuan Xu, Jing Jin, Yuan Tang. Magnetic resonance linac for locally advanced rectal cancer: a preliminary experience[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 519-523.

磁共振加速器作为一种新型的放射治疗设备，应用于直肠癌的经验较少报道。本文介绍了磁共振加速器治疗直肠癌的步骤，并报告了使用该步骤治疗6例局部晚期直肠癌的初步治疗结果。6例直肠肿瘤均退缩，其中2例（2/6）可达肿瘤完全消退，所有患者放疗期间未出现3度以上毒副反应。每次放疗实施前，MR图像显示解剖、靶区清晰，可顺利实现在线自适应放疗和实时跟踪放疗。磁共振加速器在直肠癌放疗方面具有良好的应用前景。

关键词: 直肠肿瘤, 放疗, 磁共振加速器

As an emerging radiation therapy modality, experience with magnetic resonance linac (MR-Linac) for rectal cancer is rarely reported. This article introduces a procedure for the treatment of rectal cancer with MR-Linac and reports the preliminary results of the treatment of 6 cases of locally advanced rectal cancer using this procedure. All of the rectal tumors regressed, with 2 cases (2/6) achieving complete tumor regression, and no≥G3 acute toxicities occurred during radiation therapy. Before the implementation of each radiotherapy, MR image shows the anatomy and target volume clearly, which can successfully realize online adaptive radiotherapy and real-time tracking radiotherapy. MR-linac has a good prospect in the radiotherapy of rectal cancer.

Key words: Rectal neoplasms, Radiotherapy, Magnetic resonance linac
表1 MR-Linac治疗6例局部晚期直肠癌患者的临床特点
病例 年龄 性别 分期（AJCC 8th） MRF EMVI 肿瘤下缘距肛门距离（cm）
1 68 女 T3aN2M0 IIIB期 阳性 0级 <5
2 55 男 T3bN1bM0 IIIB期 阴性 3级 <5
3 53 男 T3bN1bM0 IIIB期 阳性 4级 <5
4 63 女 T4aN2bM0 IIIC期 阳性 3级 ≥5
5 68 女 T3cN2bM0 IIIC期 阴性 3级 ≥5
6 44 男 T4bN1bM0 IIIC期 阳性 2级 <5
表2 MR-Linac治疗6例局部晚期直肠癌患者的治疗情况
病例 放疗方案 新辅助化疗方案 新辅助治疗期间毒副反应b 新辅助治疗后疗效评估 新辅助治疗后治疗选择 切除类型 病理T分期 病理N分期 TRG分级d
1 PTV 25Gy/5f序贯PGTV 4Gy/1f 4周期XELOXa Ⅱ度放射性肠炎，Ⅱ度骨髓抑制 CR 等待观察 / / / /
2 PTV 25Gy/5f 6周期XELOX Ⅱ度放射性肠炎，Ⅰ度放射性皮炎 CR 根治性手术（Dixon术c） R0 T0 N0 4级
3 PTV 25Gy/5f序贯PGTV 4Gy/1f 6周期XELOX Ⅰ度放射性肠炎 PR 根治性手术（Dixon术） R0 T3 N0 2级
4 PTV 25Gy/5f序贯PGTV 4Gy/1f 2周期XELOX Ⅱ度放射性肠炎，Ⅰ度骨髓抑制 PR 根治性手术（Dixon术） R0 T2 N0 3级
5 PTV 25Gy/5f 2周期XELOX Ⅱ度放射性肠炎 SD 根治性手术（Dixon术） R0 T4a N1 1级
6 PTV 25Gy/5f序贯PGTV 4Gy/1f 4周期XELOX Ⅰ度放射性肠炎 PR 根治性手术（Dixon术） R0 T2 N0 2级
图1 MR-Linac治疗局部晚期直肠癌的关键流程
图2 MR-Linac治疗局部晚期直肠癌的计划图像（红色轮廓为GTV，绿色轮廓为PTV，剂量覆盖好，适形度高）
图3 MR-Linac治疗局部晚期直肠癌期间实时MR监控图像（绿色轮廓为PTV，治疗期PTV对实际治疗区域覆盖满意，对正常器官保护好）
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