热放疗、放化疗和单纯放疗治疗食管癌的临床对比观察

Comparison of efficacy and toxicity of thermoradiotherapy,chemoradiotherapy and radiotherapy alone for patients with esophageal cancer

目的：比较热放疗、放化疗和单纯放疗治疗食管癌的近期疗效、不良反应及其对患者免疫功能的影响。方法：90例食管癌患者随机分为热放疗组、放化疗组和单纯放疗组,每组30例。放射治疗均采用常规放疗方法,总剂量为60Gy。放化疗组采用同步放化疗法,化疗方案为CF（顺铂＋5-氟尿嘧啶）,共化疗2个周期。热放疗组于放疗后2h内接受热疗,每次1h,每周2次。结果：放化疗组有2例患者因发生严重骨髓抑制而中止治疗。热放疗组、放化疗组和单纯放疗组的近期有效率分别为76.67%、85.71%和53.33%,放化疗组与单纯放疗组的差异有统计学意义（P〈0.05）。放化疗组的恶心/呕吐、白细胞减少和血小板减少不良反应发生率均高于热放疗组和单纯放疗组（P〈0.05）,且Ⅲ~Ⅳ度不良反应更多。热放疗组的急性放射性食管炎发生率最低（30.00%）。治疗后热放疗组的CD4＋/CD8＋比值较治疗前明显增加,而放化疗组治疗后CD3＋、CD4＋、CD8＋和CD4＋/CD8＋水平均较治疗前有所降低;治疗后单纯放疗组的CD4＋和CD4＋/CD8＋水平均明显低于热放疗组（P〈0.05）。结论：放化疗治疗食管癌的近期疗效优于热放疗和单纯放疗,但不良反应较为严重。热放疗可增强机体的细胞免疫功能。

Objective：To observe and compare the short-term responses,adverse effects and changes of immune function among thermoradiotherapy,chemoradiotherapy and radiotherapy alone treatments for patients with esophageal cancer.Methods：Ninety patients with esophageal cancer were randomly divided into thermoradiotherapy group（n=30）,chemoradiotherapy group（n=30）and radiotherapy alone group（n=30）.All patients received conventional radiotherapy with a total dose of 60 Gy in 2 Gy fractions.Thirty patients in the chemoradiotherapy group received two cycles of CF regimen（cisplatin plus 5-fluorouracil）concurrent with radiotherapy.Thermal therapy was administered during 2 h after radiation for 1 h and repeated every 2 d in the thermo radiotherapy group.The response rates,acute toxicities and immune function changes were evaluated.Results：Of thirty patients in the chemoradiotherapy group,2 discontinued the treatment due to severe myelosuppression.The short-term response rates in the thermoradiotherapy,chemoradiotherapy and the radiotherapy alone groups were 76.67%,85.71% and 53.33%,respectively,and the difference of respose rate between the chemoradiotherapy group and the radiotherapy alone group was significant（P〈0.05）.The incidence rates of nausea /vomiting,leucopenia and thrombo-cytopenia were significantly higher in the chemoradiotherapy group than those in the thermoradiotherapy and the radiotherapy alone groups（P〈0.05）.The incidence rate of acute radiation esophagitis（30.00%）induced by radiotherapy alone was the lowest among these three groups.The ratio of CD4＋/CD8＋ was increased after treatment in the thermoradiotherapy group,while the CD3＋,CD4＋ and CD8＋ levels as well as the ratio of CD4＋/CD8＋ in the radiotherapy alone group were decreased after treatment in the chemoradiotherapy group.The CD4＋ level and the ratio of CD4＋/CD8＋ were significantly lower than those in the thermoradiotherapy group.Conclusion：Compared with thermoradiotherapy and the radiotherapy alone,patients with esophageal cancer show a better response to chemoradiotherapy,but also having more severe and frequent adverse effects.The addition of thermal therapy to radiotherapy can moderately improve local control and obviously enhance T cell immune response.