中晚期食管癌三维适形放疗联合同期化疗的临床观察

Three-dimensional conformal radiotherapy combined with concurrent chemotherapy for locally advanced esophageal carcinoma

目的:观察三维适形放疗联合同期化疗治疗中晚期食管癌的毒副反应与临床疗效。方法:62例符合入组条件的中晚期食管癌患者接受三维适形放疗及同期化疗。放疗处方剂量60 Gy/30次,化疗选择LFP方案,观察患者的治疗完成情况、放化疗毒副反应及临床疗效。结果:1)61例患者如期完成放疗,化疗完成≥3个周期者29例,完成2个周期者18例,仅完成1个周期者15例。2)治疗的急性毒性反应主要为骨髓抑制和胃肠道反应,其中胃肠道反应总发生率为79.03%(49/62),白细胞减少总发生率为80.65%(50/62),急性放射性食管炎总发生率为80.65%(50/62),其中以1级和2级占88.00%(44/50)。急性放射性肺炎的总发生率为38.71%(24/62),其中1级占54.17%(13/24)。3)全组患者1、2和3年局控率分别为89.97%、70.66%和70.66%,12、和3年生存率分别为88.33%、55.78%和52.68%,中位生存期28个月。GTV最大横径≤4 cm组与>4 cm组1、2和3年生存率分别为96.88%、74.27%、68.08%和78.57%、34.83%、34.83%,χ2=7.48,P=0.006 2。结论:三维适形放疗联合LFP方案同期治疗中晚期食管癌具有可行性,多数患者能耐受,该种治疗模式初步取得了较满意的局控率及生存率,临床疗效有提高的趋势,远处转移的控制未见改善。

OBJECTIVE：To observe the acute side effects and clinical results of three-dimensional conformal radiotherapy（3DCRT） combined with chemotherapy for esophageal carcinoma.METHODS：Totally 62 patients with esophageal carcinoma received 3DCRT combined with concurrent chemotherapy of LFP.The side effects and clinical results were observed.RESULTS：1） Of all the patients,61 completed radiotherapy,29 patients completed 3 or more than 3 cycles of chemotherapy,18 completed 2 cycles and 15 completed only 1 cycle.2） The acute toxic reactions were marrow depression and gastrointestinal tract reaction mainly,49（79.03%） patients developed the side effects of nausea,vomiting and constipation,and the incidence of leucopenia was 80.65%（50/62）.Fifty patients（80.65%） developed acute radiation esophagitis with 88.00%（44/50） of grade 1 and grade 2,and 24 patients（38.71%） developed acute radiation pneumonitis with 54.17%（13/24）of grade 1.3）The 1-,2-,3-year local control rates were 89.97%,70.66% and 70.66%,respectively.The 1-,2-,3-year overall survival rates were 88.33%,55.78% and 52.68%,respectively,and the median survival time was 28 months.For the patients whose maximum trans diameter of GTV was less and more than 4 cm,the 1-,2-,3-year survival rates were 96.88%,74.27%,68.08% and 78.57%,34.83% and 34.83%,respectively（χ^2=7.48,P=0.006 2）.CONCLUSIONS：3DCRT combined with concurrent chemotherapy of LFP has its feasibility and the majority of patients could tolerate the treatment.This pattern of treatment could make well local control rate and survival rate,and the clinic effect has the potential of improvement,but the control of metastasis has no improvement.