常规分割放疗加顺铂、5-氟尿嘧啶同期化疗中晚期食管癌

Clinical Study of Conventional Fractionation Radiation and Concurrent Cisplatin and 5-Flurouracil Chemotherapy in Patients with Local Advanced Esophageal Cancer

目的评价常规分割放疗加顺铂、5-氟尿嘧啶同期化疗中晚期食管癌的疗效和近期及远期毒性反应。方法41例初治原发食管鳞状细胞癌随机分为常规分割放疗加顺铂、5-氟尿嘧啶同期化疗组(综合组)和单纯放疗组(单放组),综合组接受常规分割放疗60Gy,30分割,同期化疗:CDDP 52.5mg/m2 d1,5-Fu 700mg/m2 d1～d5,每28天重复,共4周期。单放组仅接受常规放疗70Gy,35分割。结果综合组和单放组的近期有效率分别为100%和80%(P=0.013),两组的6、12、18个月的局控率分别为88.9%、81.5%、81.5%和75.0%、49.5%、41.3%(P=0.006),生存率分别为81.2%、73.8%、59.0%和80.0%、54.2%、31.6%(P=0.085)。综合组有较重的血液学毒性,而放射性食管炎、肺炎与单放组无显著性差别。结论常规分割放疗同期化疗与单纯放疗相比,显著地提高了近期有效率和局控率,有提高生存率的趋势,毒性可耐受,值得进一步研究。

Objective To evaluate the effects and acute and late toxicities of conventional fractionation radiation plus concurrent cisplatin and 5-flurouracil chemotherapy in patients with local advanced esophageal cancer. Methods Forty one patients with primary esophagea. squamous cancer were randomized into two groups： 21 patients in combined group（CRT） received conventional fractionation radiation of 60Gy in 30 fractions with five daily fractions of 2Gy per week over a 6-week period plus concurrent chemotherapy：CDDP 52.5mg/m^2 d1,5-Fu 700mg/m^2 d1-d5,repeated 4 times every 28 days. 20 patients in radiotherapy group（RT） only received the same radiation schema exception of 70Gy in 35 fractions. Results Response rates in CRT and RT were 100% and 80%, respectively（P= 0.013）. Six-month, 12-month and 18-month local control rates in two groups were 88.9%, 81.5%, 81.5% and 75.0% ,49.5%, 41.3%, respectively（P = 0.006）. Six-month, 12-month and 18-month survival rates in two groups were 81.2%, 73.8%, 59.0% and 80.0%, 54.2%, 31.6%, respectively（ P = 0.085 ）. Hematological toxicities in CRT were more severe than that in RT,while radiation-induced esophagitis and radiation-induced pneumonia was not significantly different in two groups. Conclusion CRT significantly improves response rates and local control rates, and it shows the improved tendency of survival rates compared with RT. The toxicities in CRT were tolerated. CRT was warranted to further study.