Ⅱ、Ⅲ期食管上段癌后程三维适形放疗联合化疗模式探讨

Investigation of the efficacy of different patterns of late-course three-dimensional conformal radiotherapy plus chemotherapy in patients with stage Ⅱ,Ⅲ upper esophageal carcinoma

目的 观察Ⅱ、Ⅲ期食管上段癌后程三维适形放疗联合化疗不同模式的临床疗效.方法 将130例Ⅱ、Ⅲ期食管上段癌患者随机分组,放疗联合新辅助化疗组（新辅助组）43例,同步放化疗组（同步组）45例,放疗序贯辅助化疗组（辅助组）42例.化疗方案和放射治疗方法3组相同.结果 1、3、4年生存率辅助组分别为61.9%、31.0%、23.8%,同步组分别为82.2%、46.7%和35.6%,新辅助组分别为76.7%、39.5%和27.9%,中位生存时间辅助组为23.5个月,同步组为32.8个月,新辅助组为29.1个月（χ^2=12.8599,P〈0.05）,同步组和新辅助组与辅助组比较疗效更优（χ^2值分别为12.4479、4.6627,P均〈0.05）.结论 针对Ⅱ、Ⅲ期食管上段癌采取后程三维适形放疗联合化疗可以提高疗效,同步放化疗或者放疗联合新辅助化疗的疗效优于放疗序贯辅助化疗.

Objective To study the effects of different patterns of late-course three-dimensional conformal radiotherapy combined with chemotherapy in patients with stage Ⅱ,Ⅲ upper esophageal carcinoma.Methods One hundred and thirty patients with stage Ⅱ,Ⅲ upper esophageal carcinoma were randomly divided into three groups. There were 43 patients in radiotherapy plus neochemotherapy group （Neoadjuvant group）,45 patients in concurrent radiochemotherapy group （Concurrent group）,and 42 patients in radiotherapy plus adjuvant chemotherapy group （Adjuvant group）.The chemotherapy regimen and radiotherapy were identical in three groups.Results The 1,3,4year survival rates were 61.9%,31.0% and 23.8% in adjuvant group,82.2%,46.7% and 35.6% in concurrent group,and 76.7%,39.5% and 27.9% in neodajuvant group,respectively.The median survival time was 23.5,32.8 and 29.1 months in the above three groups.There was significant difference among the three groups（χ^2=12.8599,P〈0.05）,with better effect in concurrent group and neoadjuvant group compared to adjuvant group（χ^2=12.4479,4.6627,P〈0.05）.Conclusions Different patterns of late-course three-dimensional conformal radiotherapy combined with chemotherapy may improve the outcome of upper esophageal carcinoma with stage Ⅱ,Ⅲ,especially better for concurrent radiochemotherapy and neoadjuvant than adjuvant.