顺铂和替加氟及去甲斑蝥酸钠联合放疗治疗中晚期食管癌的临床研究

Clinical study of radiotherapy plus chemotherapy for patients with middle-and advance-stage esophageal carcinoma

目的探讨联合化疗提高中晚期食管癌放射治疗的方法。方法186例食管癌患者根据入选标准随机分组,92例进入放射治疗+化疗组(放化组),94例进入单纯放射治疗组(单放组)。化疗方案:替加氟800 mg、去甲斑蝥酸钠20 mg均为第1～5天;顺铂30 mg第1～3天;化疗与放射治疗同步第1、4周进行。放射治疗:60Coγ线照射,先设前后对穿野DT40 Gy/4.0周,结束后成角缩野追加24～28 Gy/2.4～2.8周。结果放化组3,5年生存率分别为22.0%和15.9%;单放组3,5年生存率分别为13.8%和8.8%,两组间5年生存率差异有显著性(P=0.040)。毒副作用以综合组较明显,但患者可以耐受。两组的主要死亡原因是局部复发,两组1,3,5年局部复发率差异有显著性。但放化组死于远地转移及淋巴结转移的病例,与单放组比较差异无显著性(χ2=3.17,P>0.05)。结论以顺铂、替加氟、去甲斑蝥酸钠联合化疗加放射治疗中晚期食管癌可以提高疗效。虽毒副反应有所增加,但患者均可耐受。

Objective To evaluate the efficacy of radiotherapy combined with chemotherapy in treatment of patients with middle-and advanced-stage esophageal cancer.Methods 186 patients with middle-and advanced-stage esophageal cancer were randomized into two groups： 92 treated with radiotherapy combined with chemotherapy（R-C）and 94 with radiotherapy alone（R）.The chemotherapy regimen included tegafur 800 mg on d1-d5,injectio natarii norcantharidatis 20 mg on d1-d5,cisplatin 30 mg on dl-d3.When radiotherapy（RT） was started,chemotherapy（CT） was started on the same day.The patients were irradiated with anteroposterior（AP）and posteroanterior（PA）fields to a dose of 40 Gy in 4.0 weeks,followed by a boost of 24-28 Gy in 2.4-2.8 weeks through oblique fields.Results The 3-and 5-year survival rates were 22.0% and 15.9% in the R＋C group and 13.8% and 8.8% in the R group.The difference was statistically significant in 5-year survival rate（P=0.040）.The toxic and side effects were tolerable and similar in the two groups.The leading cause of death in both groups was local recurrence.The 1-,3-,5-year local recurrence rates had significant differences between the two groups.Twenty two patients（37.0%）in the R＋C group and twenty nine（39.0%）in the R group died of distant metastasis and/or lymph node metastasis,the difference was not statistically significant（χ2 =3.17,P0.05）.Conclusion Chemotherapy with tegafur,cisplatin plus injectio natarii norcantharidatis plus radiotherapy can improve the outcome of esophageal cancer.Although with the toxic and side effects of the combined modality are severer than radiation alone,yet they are well tolerated.