支架置入结合三维适形放疗加同步化疗治疗中晚期食管癌疗效观察

Clinical analysis of combined esophageal stent inserting with three-dimensional conformal radiotherapy and concurrent chemotherapy on esophageal carcinoma

背景与目的:晚期食管癌患者预后差,目前仍无标准治疗方案。本研究旨在观察食管支架置入术联合放化疗治疗中晚期食管癌的临床可行性及疗效。方法:回顾性分析66例晚期不能手术的食管癌患者。治疗组36例,前期利用食管支架置入术解决中晚期食管癌患者病变部位的狭窄程度,后期针对原发病实施三维适形放射治疗,在放疗第1、3、5周同步静脉滴注氟尿嘧啶(5-FU)500mg,第1天至第5天。对照组30例,单纯行食管支架置入术。根据WHO对实体瘤的近期疗效评价标准和吞咽困难Stooler分级进行疗效评价。结果:治疗组CR5例(13.9%),PR26例(72.2%),近期有效率(CR+PR)为86.1%,治疗组6个月、12个月近期生存率分别为88.9%、72.2%;对照组分别为53.3%、26.7%。两组比较差异有显著性(P<0.01)。治疗组的不良反应主要是白细胞减少和放射性食管炎发生率增加,但患者可耐受。结论:支架置入结合三维适形放疗加同步小剂量5-FU化疗可提高晚期食管癌患者的近期有效率及生存率,患者体质明显改善,生活质量明显提高,不良反应虽增加,但患者均能耐受。作为临床上治疗中晚期食管癌的一种手段,值得推广。

Background and purpose： The prognosis of advanced esophageal carcinoma is poor, there are no standard regimens for these patients. This study was to observe and evaluate the clinical feasibility and efficacy of combined esophageal stent insertion with radiotherapy and concurrent chemotherapy in the treatment of locally advanced esophageal carcinoma. Methods： 66 patients with esophageal carcinoma who were not suitable for operation were analyzed retrospectively. In the therapy group, stent was placed in order to relieve esophageal stenosis, and then followed by 3D-CRT and concurrent chemotherapy, while patients in the control group were treated with the placement of stent alone. According to the evaluating standards of WHO and Stooler classification, we evaluated the efficacy. Results： In the study group, 72.2% of 36 cases was observed as partial response（PR）, and 13.9% with complete response（CR）, overall response rate was 86.1%. 6 and 12 months survival rates were 88.9% and 72.2% in the study group, compared to 53.3% and 26.7% in the control group, respectively（P〈0.05）. Conclusion： The result of 3D-CRT and concurrent chemotherapy plus stent placement was effective in the treatment of locally advanced esophageal carcinoma, it may improve the quality of life and survival time of the patients compared to that treated by stent placement alone.