局部晚期食管癌紫杉醇同步放化疗的临床观察

clinical research of paclitaxel concurrent chemoradiotherapy for locally advanced esophageal cancer

目的探讨局部晚期食管癌应用紫杉醇同步放化疗治疗的疗效及毒副反应。方法 60例局部晚期食管癌患者,随机分成两组(单放组和放化组),单放组28例,放化组32例。两组均采用6MV-X射线三维适形放射治疗,食管癌原发灶剂量60～66Gy,区域淋巴结剂量50～60Gy。放化组放疗第1天开始同时给予紫杉醇40mg/m2,每周给药1次,连用6周。结果单放组和放化组的有效率(CR+PR)分别为67.9%和93.8%,差异有显著性(P<0.05)。两组的1﹑3﹑5年生存率分别为71.4%﹑25.0%和14.3%,84.4%﹑59.4%和31.3%,总生存率差异有显著性(P<0.05)。单放组和放化组的转移率分别为42.86%(12/28)和18.75%(6/32),两组间远处转移率有显著性差异(P<0.05)。同步放化疗组的毒副反应高于单纯放疗组。结论同步放化疗可提高局部晚期食管癌的有效率、总生存率,降低远处转移率,但毒副反应增加,但患者能够耐受。

Objective To observe the efficacy and toxicity of paclitaxel concurrent chemoradiotherapy for locally advanced esophageal carcinoma. Methods Total 60 patients with locally advanced esophageal cancer were divided randomly into two groups,28 patients in group A received only radiotherapy,while 32 patients in group B received concurrent chemoradiotherapy,for both groups,the same radiation technic was given with 3-dimensional conformal radiation therapy （ 3DCRT） with 6MV X ray. the total dose was 60 ～ 66Gy/30 ～ 33f for primary tumor,while the dose was50 ～ 60 Gy/25 ～ 30f for involved regional lymph nodes. For group B patients were also given with concurrent chemotherapy （ paclitaxel 40 mg/m^2 d1,one time per week for six weeks） . Results The overall response rate （ CR ＋ PR） of groupA received only radiotherapy and group B received concur-rent chemoradiotherapy were 67. 9% and 93. 8% respectively,The difference between the two groups was statis-tically （ P〈0. 05） . The one,three and five year survival rate were 71. 4% 、25% and 14. 3% in group A ,while survival rate were 84. 4% 59. 4% and 31. 3% in group B. The difference of survival rates between the two groups was statistically （ P〈0. 05） . The metastatic rate of group A was higher than that of group B （ 42. 86% versus 18. 75% ） . The difference between the two groups was statistically （ P〈0. 05） . Toxic and adverse effects were more serious in group B than that in group A. However all patients were well-tolerated. Conclusion Paclitaxel concurrent chemoradiotherapy for locally advanced esophageal cancer may be a more effective,longer overall survival,less metastatic rate,and improved and well-tolerated toxic and adverse effects in patients with locally advanced esophageal cancer.