甘氨双唑钠对食管癌根治性放疗后复发再程放疗的增敏作用

Sensitivity enhancement of sodium glycididazole in re-radiotherapy against local recurrent esophageal carcinoma after radical radiotherapy

目的：观察甘氨双唑钠（CMNa）对食管癌根治性放疗后复发再程放疗的放射增敏作用及不良反应．方法：2001-07／2003-06，收治食管癌放疗后局部复发行再程放疗的患者46例，均为首程放疗结束后疗效达到基本痊愈或明显缓解者，一段时间后又出现吞咽情况恶化等临床症状，经病理检查确诊为复发，随机分为研究组和单放组，每组23例，研究组：CMNa800mg／m^2，用生理盐水100mL稀释溶解后静脉输入，输入结束后60min内进行放射治疗，3次／wk，从再程放疗开始连续用药至放疗结束．两组患者均采用加速器6MV-X线，体外等中心常规放疗或三维适形放疗，每次2Gy，5次／wk，照射剂量50～66Gy．对比两组近期疗效、局部控制率、生存率及毒副反应差别．进行X线和CT检查客观评价．结果：研究组近期有效率（CR＋PR）73．9％，单放组为43．5％（P〈0．05）．两组的1，2，3a局控率分别为65．2％，39．1％，30．4％和43．5％，17．4％，8．7％（P〈0．05）；1，2，3a生存率分别为87．0％，47．8％，34．8％和69．6％，21．7％，13．0％（P〈0．05）．结论：CMNa可以增加食管癌放疗后复发病灶的放射敏感性，放疗合并使用CMNa可提高食管癌根治性放疗后复发的近期疗效、局部控制率及生存率．

AIM： To investigate the sensitivity enhancement of sodium glycididazole （CMNa） in re-radiotherapy against local recurrent esophageal carcinoma after radical radiotherapy. METHODS： Such cases （n = 46） who recurred after they had received radical radiotherapy and were confirmed by pathology from July, 2001 to June, 2003 were divided randomly into study group and control group. Before re-radiotherapy, the patients in study group were treated by intravenous infusion of CMNa 800 mg/m^2 diluted in 100 mL sodium chloride, 3 fractions a week through the total therapy course. The radiotherapy was carried out 60 min after each infusion. All patients received conventional radiotherapy or three dimensional conformal radiotherapy at 2. 0 Gy each time, 5 fractions a week to a total dose of 50 - 60 Gy. The short-term therapeutic effect, local control rate, survival rate and side effects were compared in the 2 groups. CT and barium meal examinations of esophagus were performed. RESULTS ： The short-term effective rates （CR ＋ PR ） were 73. 9% in study group, 43.5% in control group （ P 〈 0.05 ）. The 1-, 2- and 3- year local control rates were 65.2%, 39. 1% and 30.4% in study group, 43.5%, 17.4%, and 8.7% in control group （P〈 0.05）. The 1-, 2- and 3-year survival rates were 87. 0%, 47.8% and 34.8% in study group, 69.6%, 21.7% and 13.0% in control group （P 〈0.05）. The incidence rates were not found different among the 2 groups. CONCLUSION： CMNa can enhance the radiosensitization of the local recurrent esophageal carcinoma cells. Re-radiotherapy combined with CMNa can improve the short-term effective rates, local control rate and survival rate of the patients with local-recurrent esophageal carcinoma after radical radiotherapy.