“序贯夹心式”化、放疗治疗进展期食管癌的临床研究

The clinical research of chemotherapy and radiotherapy for the advanced esophageal carcinoma by the sequence double-layered way

目的:观察“序贯夹心式”化、放疗治疗进展期食管癌的近期疗效、不良反应、生存期及年复发率。方法:采用“静脉化疗2周期局部放疗静脉化疗2周期”的序贯夹心式方法。静脉化疗运用PFL方案,顺铂(PDD)25mg/m2,d1～d3;亚叶酸钙(LV)120mg/m2,d1～d5;氟尿嘧啶(5Fu)500mg/m2,d1～d5,均静脉滴注,21天为1周期。放疗运用外照射,每次2Gy,每周5次,共30～35次,总照射剂量60～70Gy。每周期化疗前及全程治疗结束后2个月内行食管钡剂造影、CT及腹部超等检查,随访时间为5年。结果:近期总有效率83.6%;1年生存率71.4%,3年生存率44.9%,5年生存率32.7%,中位生存期18.9月。不良反应主要表现在胃肠道反应与骨髓抑制。胃肠道反应有轻度至中度的恶心、食欲下降、呕吐;骨髓抑制常见为白细胞总数下降,但多为Ⅱ～Ⅲ度,红细胞、血小板减少不常见。结论:“序贯夹心式”化、放疗治疗进展期食管癌较单一治疗方法有明显的优势,且真正体现了食管癌综合治疗的内涵和全身、局部治疗有机结合的价值,值得临床广泛应用。

Objective：To observe the clinical effect, adverse reaction, survival years, and yearly recurrence rate. Methods：At first, it had been used the vein chemotherapy for two periods, and then applied the local radiotherapy, finally used the vein chemotherapy for the two periods again. The vein chemotherapy was used the PFL regimen, namely, cisplatin had been used the the intravenous drip for three days,40mg per day; Lederfuline used before 5-fluorouracil for five days,2OOmg per day ;5-Fluorouracil used for five days,750mg per day,one cycle was 21 days. The radiotherapy had been used the outer irradiation,it was five times a week,was 2Gy once, was 30 ～35 times in all,total irradiation dosage was 60 ～70Gy. Each patient was checked with the esophageal barium radiography, CT scan, and the abdomen B ultrasound,and so on. The fullow-up survey time was 5 years. Results：The total recent effect rate was 83.6% ;The survival rate of one year was 71.4% ,three years was 44. 9% ,five years was 32. 7%. Middle survival time was 18. 9 months. The adverse reaction manifested mainly the reaction of gastrointestinal tract and the suppression of bone marrow. The reaction of gastrointestinal tract was slight or moderate nausea, vomiting, and anorexia ;The suppression of bone marrow often had the reduction of WBC, but the more reduction degree was Ⅱ ～Ⅲ ,the reduction of RBC and PLT was rarely come out. Conclusion：The sequence double-layered way of the combination chemotherapy and radiotherapy is more superiorities than single therapy way on treating esophageal carcinoma, and it embodies really the intention of the comprehesive therapy of esophageal carcinoma, embodies really the value of the integrating of the whole therapy and local therapy of esophageal carcinoma. It is valuable to be used extensive in clinic.