放疗联合方克顺铂同步或序贯化疗治疗老年晚期食管癌的临床研究

Study on concurrent versus sequential chemoradiotherapy with tegafur and cisplatin for old patients with locally advanced esophageal carcinoma

目的评价放疗联合方克顺铂同步或序贯化疗治疗老年食管癌的疗效及毒副反应。方法将62例〉70a的老年食管癌病人随机分成两组，同步放化疗组（31例）：放疗d1即同时开始化疗；序贯放化疗组31例：入组后先予化疗2个周期，再单独予放疗，放疗结束后再化疗2～3个周期，放疗采用6～Coy常规分割放疗，1．8～2．0Gy／次，5次／wk，总剂量64～68Gy／6～7wk完成。结果同步组和序贯组的有效率分别为93．6％、83．9％，1a、3a局部控制率分别为77．4％与67．7％和48．4％与38．7％，两组比较差异无统计学意义（χ^2=3．02，P=0．065）。同步组和序贯组的1a、3a生存率分别为74．2％与64．5％和45．1％与32.3％，两组比较差异无统计学意义（χ^2=2．32，P=0．073）。同步组的血液学毒性、放射性食管炎以及放射性肺炎均高于序贯组，多数为1以级。结论老年晚期食管癌病人同步治疗组较序贯治疗组的疗效提高，生存期延长，毒副作用增加，但病人可以耐受。

Objective To evaluate the effect and clinical toxicity of concurrent and sequential chemo-radiotherapy （CRT） with tegafur and cisplatin for old patients with locally advanced esophageal carcinoma. Methods Sixty-two patients over seventy years old with locally advanced esophageal carcinoma were randomly assigned into two groups. In concurrent CRT group （31 cases）, when radiotherapy （RT） was the started, chemotherapy （CT） was started on the first day. In equential CRT group （31 cases）, accepted 2 cycles CT before RT, when RT was finished, then accepted 2～3 cycles CT, all patients were treated by 6～Co Y ray, conventional fractionation radiotherapy 1.8-2.0Gy/f,5f/w, the total doses was 64～68Gy/6～7 week. Results In concurrent and sequential CRT group, overall response rates were 93.6% and 83.9%, 1-,3-year local control rate was 77.4% and 67.7% in concurrent CRT group, 48.4% and 38.7% in sequential CRT group, and no difference was found in two group local control rate （χ^2=3.02, P=0.065）. The l-year and 3-year survival rates were 74.2% and 64.5% in the concurrent CRT group, and 45.1% and 32.3% in the sequential CRT group. No difference was found in two group survival rate （χ^2=2.32, P=0.073）. Blood cell declined and esophageal toxicity were significantly more frequent in the concurrent CRT group than those in the sequential CRT group （P〉0.05）. However, the toxicities were tolerable by the treatment. Conclusions Compared concurrent CRT with sequential CRT group of locally advanced esophageal carcinoma, the efficacy might be improve, the survival time might be lengthen, and side effects could be increasing but tolerable.