调强或三维适形放疗联合TP方案化疗治疗局部中晚期食管癌的临床研究

Intensity-modulated or 3-D conformal radiotherapy combined with chemotherapy with docetaxel and cisplatin for locally advanced esophageal carcinoma

目的观察评价调强或三维适形放疗联合多西他赛与顺铂治疗局部中晚期食管癌的疗效及不良反应。方法局部中晚期的60例食管癌患者随机分为两组:A:30例调强放疗联合TP(多西他赛及顺铂)方案化疗组,B:30例三维适形放疗联合TP(多西他赛及顺铂)方案化疗组。放射剂量为64Gy/30次/6周。结果近期疗效,总有效率(CR+PR)调强化疗组的90%好于适形放疗组的80%,但两组比较差异没有统计学意义(P>0.05)。1、2、3年生存率分别为调强化疗组86.7%、70.0%、66.7%及适形化疗组的70.0%、63.3%、63.3%,两组比较差异没有统计学意义(P>0.05)。比较两组肺V20、V30,调强化疗组有优势(P<0.05),两组急性放射性食管炎比较差异不大,无统计学意义(P>0.05)。结论调强放疗联合TP(多西他赛及顺铂)方案化疗治疗局部中晚期食管癌在目前是一种较有效的方法。

Objective To evaluate the therapeutic effect and toxicity of intensity-modulated radiation therapy （IMRT） or three-dimensional conformal radiotherapy combined with chemotherapy （3-DCRT） with docetaxel and cisplatin in the treatment of locally advanced esophageal carcinoma. Methods Sixty patients with locally advanced esophageal carcinoma were randomly assigned in two equal groups to receive IMRT or 3-DCRT, both combined with the chemotherapy with docetaxel and cisplatin. The total dose of radiotherapy was 64 G3~ administered in 30 fractions in 6 weeks. Results The complete response rate （complete and partial remissions） of IMRT group was 90.0%, significantly higher than the rate of 80.0% in 3-DCRT group （P〉0.05）. The 1-, 2-, and 3-year survival rates of IMRT group were 86.7%, 70.0% , and 66.7~/O, as compared to 70.0%, 63.3%, and 63.3% in 3-DCRT group, respectively, showing no significant differences between the two groups （P〉0.05）. IMRT showed advantages over 3-DCRT in terms of the V20 and V30 parameters of the lung （P〈0.05）, and the incidences of radiation-induced esophagitis were comparable between the two groups （P〉0.05）. Conclusion When combined with the chemotherapy with docetaxel and cisplatin, IMRT appears to be a more effective treatment than 3-DCRT for locally advanced esophageal cancer.