不同化疗方案同步放疗治疗食管癌的比较分析

Contrast Analysis of Difference Chemotherapy Regimens on Esophageal Cancer

目的比较分析放疗同期顺铂氟尿嘧啶方案化疗与同期紫杉醇顺铂方案化疗的疗效及毒副反应。方法回顾性分析2003-01～2006-12间,98例放疗同期化疗的食管癌病例,临床分期Ⅱ～Ⅲ期。均为CT定位,常规分割,三维适形放疗,总剂量60～65 GY。均于放疗第1、22 d配合化疗,根据同期化疗方案的不同分为两组：45例配合顺铂加氟尿嘧啶方案,为A组;43例配合紫杉醇加顺铂方案,为B组。结果所有患者均随访至2010-01,随访率为97%。两组完全缓解率分别为：72%、33%（2χ=4.63,P〈0.05）。1、2、3年局部控制率两组分别为：79%、65%、51%、89%、75%、60%（2χ=3.12,P=0.056）。1、2、3年生存率两组分别为：74%、53%、41%、84%、65%、52%（2χ=2.85,P=0.091）。急性毒副反应,白细胞减少及肝功能异常的发生率B组明显高于A组;放射性肺炎及放射性食管炎发生率两组无明显差异。结论适形放疗同步紫杉醇顺铂方案化疗治疗食管癌较顺铂氟尿嘧啶方案可明显提高完全缓解率及局部控制率,但生存率提高无显著性。毒副反应：骨髓抑制及肝功能异常发生率较高,但经积极治疗后可耐受,能够继续完成治疗。

Objective To compare the efficacy and toxicity between the homeochronous radiotherapy regimen with cisplatin-fluorouracil and homeochronous chemotherapy of paclitaxel-cisplatin regimen.Methods Retrospective analysis of 2003-01 ～ 2006-12 period,clinical stage Ⅱ ～ Ⅲ,98 patients with concomitant chemotherapy for esophageal cancer radiotherapy patients.All cases were adopted three-dimensional conformal radiotherapy with CT location,conventional fractionation,Total dose is 60 ～ 65 GY.Radiotherapy combined with chemotherapy was performed in NO.1 and 22d,According to the different chemotherapy regimens,the cases were divided into two groups,45 patients with cisplatin and fluorouracil is group A： 43 patients with paclitaxel plus cisplatin is group B.Results All patients were followed up to 2010-01 and the follow-up rate was 97%.The complete remission rates of two groups were 72%,33%（χ2=4.63,P0.05）.The local control rate of two groups in 1,2,3 year respectively： 79%,65%,51%,89%,75%,60%（χ2=3.12,P=0.056）.The survival rate in 1,2,3 year of the two groups were： 74%,53%,41%,84%,65%,52%（χ2=2.85,P=0.091）,The incidence of Acute toxicity side effect,leukopenia and liver function abnormal in group B was significantly higher than that in group A.There was significant difference in the incidence of radiation pneumonitis and esophagitis between two groups.Conclusions Compared with fluorouracil and cisplatin regimen,conformal radiotherapy combined with paclitaxel and cisplatin chemotherapy could significantly improve the complete remission rate and local control rate in esophageal cancer,But the survival rate was not significant.It was higher incidence in the aspect of toxicity,bone marrow suppression and abnormal liver function,However,the patients could tolerated by the active treatment and can continue to complete the treatment.