同时放化疗治疗晚期食管癌的临床研究

Clinical effect of concurrent chemoradiotherapy for advanced esophageal cancer

目的 评价同时放化疗治疗晚期食管癌的疗效、毒性及可行性。方法 采用同时放化疗治疗晚期食管癌患者75例，化疗第1-5天，替加氟800mg／a、顺铂20mg／a，21d为1周期；同时进行常规分割放疗60～70Gy。治疗后4周评价疗效，进行病灶治疗前后的自身对照t检验，随访并采用Kaplan-Meier法评估生存率。结果完全缓解14．7％，总有效率64％，治疗前后可测量双径的病灶分别为（10．53±2．87）cm^2和（4．69±1．25）cm^2（P=0．012），只能测量单径的病灶分别为（7．86±2．01）cm和（3．83±1．08）cm，（P=0．007），差异有统计学意义。3级治疗毒性主要为恶心、呕吐（21．3％）和放射性食管炎（8％），无4级及以上治疗毒性。1年生存率61．3％，2年生存率30．7％。结论 同时放化疗治疗晚期食管癌疗效肯定，毒副反应患者能够耐受，值得进一步研究。

Objective To explore the effects, toxicity and safety of concurrent chemoradiotherapy for esophageal cancer, which remains controversial, especially for advanced patients. Methods A total of 75 patients with esophageal cancer having T4 tumor or N1 regional lymph node invasion or distant lymph node metastasis（Mla） were enrolled in this study. FT-207 800 mg/d and CDDP 20 mg/d were administered on days 1-5 and 22-26. Fractionated radiotherapy was performed from day 1 and a total dose of 60-70 Gy was delivered at the rate of 2 Gy per fraction. A t-test was used to compare the size of lesions before and after therapies. The overall survival time was determined by the Kaplan-Meier method. Results The overall response rate was 64% and the complete response rate was 14.7 %. The size of lesions that could be determined in two directions was （ 10.53± 2.87） cm^2 before therapies and （4.69±1.25）cm^2 after therapies （ P = 0.012）. The size of lesions that could be measured only in one direction was （7.86 ±2.01） cm before therapies and （3.83 ± 1.08） cm after therapies （ P = 0. 007）. The toxicity of the most common grade 3 was endoesophagitis（8% ） and nausea and vomiting （21.3%） and of grade 4 was not observed. The 2-year survival rate was 30.7 %. Conclusion Based on the overall response rate and the toxicity of treatments, the results obtained from the present trial are promising. Concurrent chemoradiotherapy is currently suitable for patients with advanced esophageal cancer.