食管癌后程加速超分割放射治疗同步化疗的远期疗效

Long-term efficacy of late course accelerated hyperfractionation radiotherapy combined with synchronous chemotherapy for esophageal carcinoma

目的:评价后程加速超分割放射治疗加顺铂、氟尿嘧啶同步化疗治疗食管癌的远期疗效和毒副反应.方法:115例食管癌患者随机分成单纯后程加速超分割放射治疗组(后超组)58例和后程加速超分割放射治疗加顺铂、氟尿嘧啶同步化疗组(综合组)57例.后超组前2/3疗程为常规分割(2Gy/次,5次/wk)照射36～40Gy后缩野改加速超分割(1.5Gy/次,2次/d)照射27～30Gy.综合组在后超组的基础上静脉内输注顺铂20mg/d,氟尿嘧啶500mg/d,连用5d为1周期.分别在第1,4wk实施,共2个周期.结果:综合组1,3和5a生存率(分别为80.7%,50.9%和40.4%)稍优于后超组(分别为74.1%,34.5%和25.9%),但差异无显著性(χ2=3.392,P=0.070).两组晚期放射反应发生率差异无显著性,主要为放射性食管狭窄和肺纤维化.结论:与单纯后程加速超分割放射治疗相比,后程加速超分割放射治疗加顺铂、氟尿嘧啶同步化疗有提高食管癌5a生存率的趋势,但并不增加晚期放射反应.

AIM： To investigate the long-term efficacy and adverse effects of late course accelerated hyperfractionation （LCAH） radiotherapy combined with cisplatin and fluorouracil chemotherapy for esophageal carcinoma. METHODS： Of 115 consecutive patients with esophageal carcinoma, 57 cases were randomly assigned to combined treatment group of LCAH radiotherapy and synchronous chemotherapy by cisplatin and fluorouracil, and 58 cases to simple hyperfractionation group （HF）. All patients in HF group were treated with conventional fractionation regimen during the first two thirds of the course with total dose 36-40 Gy （2 Gy/fraction, 5 times a week） , followed by LCAH in reduced fields, with dose of 27-30 Gy （ 1.5 Gy/fraction, twice a day）. Patients in combined treatment group , in addition to LCAH, intravenous infusion of cisplatin 20 mg/d, and fluorouracil 500 mg/d, was given for 5 consecutive days as a course in week 1 and 4. RESULTS： The 1-, 2- and 5- year survival rates in combined treatment group （ 80. 7% , 50.9%, and 40.4% , respectively ）seemed to be superior to those in HF group（ 74.1% , 34.5% , and 25.9% , respectively ） , however, no marked improvement was established（χ^2 = 3. 392, P = 0.070 ）. No significant differences between the main common late adverse reactions in the two groups were found, including esophageal stricture and lung fibrosis. CONCLUSION： In comparison with HF, the combined treatment tends to promote the 5-year survival rate, yet does not increase the late adverse reactions.