局部晚期食管鳞癌后程加速超分割放疗联合化疗的临床研究

Late-course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma

目的研究后程加速超分割放疗联合化疗治疗局部晚期食管鳞癌的疗效。方法将76例局部晚期食管鳞癌患者随机分为后程加速超分割放疗联合化疗(LCAF+CT)组及常规放疗联合化疗(CF+CT)组。LCAF+CT组于放疗前先行诱导化疗2次,化疗后先行常规分割放疗至36Gy,缩野后程加速超分割放疗至原发灶总剂量60～66Gy。CF+CT组化疗方法与LCAF+CT组相同,放疗采用常规分割,原发灶总剂量为60～66Gy。结果LCAF+CT组的1,3,5年生存率分别为81.6%,47.4%,34.2%,CF+CT组的1,3,5年生存率分别为73.7%,31.6%,18.4%。两组间3,5年生存率比较差异有统计学意义(P<0.05)。LCAF+CT组毒副反应较重,两组的死亡原因主要为局部复发,其次为远处转移,差异无统计学意义(P>0.05)。结论LCAF+CT治疗局部晚期食管鳞癌,可以提高疗效,延长生存期,虽毒副反应略增加,但患者均可耐受。

Objective To evaluated the treatment results of late-course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma. Methods 72 patients with advanced esophageal cancer were randomized into two groups. The late-course accelerated hyperfraetionated radiotherapy combined with chemotherapy （LCAF＋CT）group received the induction chemotherapy for two cycles, followed by conventional fraetionation radiotherapy to a dose of 36 Gy, then changed into accelerated hyperfractionated radiotherapy to a total dose of 60 - 66 Gy. The conventional fraetionation radiotherapy combined with chemotherapy （CF＋CT）group received the chemotherapy that it was similar to LCAF＋CT group, and used the conventional fraetionation radiotherapy to a total dose of 60 - 66 Gy. Results The 1-, 3- and 5-year survival rates were 82.3 %, 51.6 %, 38.2 % in the LCAF＋CT group, and 73.8 %, 31.5 %, 18.6 % in the CF＋CT group. The differences of 3- and 5-year survival rates were statistically significant （P 〈0.05）. The toxic and side effects of the LCAF＋CT group were more severe than those of the CF＋CT group. The main cause of death was local recurrence and the next cause was distant metastasis in the two groups. The diffierenee was not statistically significant（P 〉0.05）. Conclusion Late-eoures accelerated hyperfraetionated radiotherapy combined with chemotherapy might improve the treatment efficacy of advanced esophageal cancer and lengthen the suvival time. The toxic and side effects of LCAF＋CT group were more severe than those of CF＋ CT group, but they were well tolerable.