低剂量放疗同步大剂量化疗治疗食管癌的临床研究

Concurrent chemotherapy with low-dose radiotherapy for esophageal carcinoma

目的观察低剂量放疗同步大剂量化疗治疗食管癌的疗效及毒性反应。方法83例食管鳞癌按治疗方法分为单纯根治剂量放疗组42例(RT组)和低剂量放疗同步大剂量化疗组41例(CRT组)。放疗采用60Coγ射线或8mVX射线,常规分割,2Gy/次,5次/周。RT组总剂量62￣70Gy,CRT组总剂量50Gy。CRT组放疗第1天起同步使用氟尿嘧啶750mg/m2,第1～4天静脉滴入,顺铂60mg/m2,第1天静脉滴入,第1、5、8、11周重复,共4个周期。结果RT组和CRT组的1、2、3年局部控制率分别为66.7%、50.0%、42.9%和87.8%、73.2%、70.7%,1、2、3年生存率分别为52.5%、33.3%、14.3%和75.6%、65.9%、41.5%,两组比较差异有统计学意义(均P<0.05)。CRT组急性放射性食管炎及骨髓抑制发生率高于RT组,但可以耐受。结论食管癌低剂量放疗同步大剂量化疗较单纯根治剂量放疗有较好效果,毒副反应可以耐受。

Objective To evaluate the efficacy of concurrent chemotherapy with low-dose radiotherapy for esophageal carcinoma and its side effects. Methods Eighty three patients with esophageal carcinoma were divided into radiotherapy alone group （RT, n=42）and radio-chemotherapy group（CRT, n=41）. ^60Co or 8my X-ray with conventional fractionation （2 CGy daily, 5 times a week） were used. Patients in RT group were given a total dose of 62-72 CGy/DT and patients in CRT group were given a total dose of 50 CGy/DT with concurrent 5-Fu 0.75/m^2 , d1-d4 and DDP 60mg/m^2 dl in 1st, 5th, 8th, 11th week, 4 cycles in total. Results The 1-, 2- and 3- year survival rates were 52.5%, 33.3 % and 14.3% in RT group, while those were 75.6 %, 65.9 % and 41.55 in CRT group （X^2=7.650,P〈0.05）. The 1-, 2-, and 3-year local control rates were 66.7%, 50.0%, 42.9 % and 87.8 %, 73.2%, 70.7% （X^2=6.563 ,P〈0.05） in two groups respectively. The incidence rate of acute radiation esophagitis and bone marrow suppression was higher in CRT group than that in RT group. Conclusion The efficacy of concurrent chemotherapy with low-dose radiotherapy is better than radiotherapy alone.