食管癌同期放化疗的价值研究

The study of treatment value of concurrent chemotherapy for patients with esophageal carcinoma received three-dimensional conformal radiotherapy or intensity modulated radiotherapy

目的观察中晚期食管癌同期放化疗与单纯放疗疗效及不良反应。方法搜集2006-2009年本科收治的中晚期食管癌患者209例，同期放化疗105例，单纯放疗104例。三维适形放疗117例，调强放疗92例，处方剂量中位数均为60Gy。用氟尿嘧啶、顺铂、亚叶酸钙方案第1、5周同期给予化疗。观察患者治疗完成情况并进行生存分析。结果总随访率为99．0％，随访满2、3年者分别为99、44例，其中同期放化疗和单纯放疗的分别为45、14和54、30例。同期放化疗与单纯放疗的1、2、3年局部控制率分别为88．1％、69．2％、66．2％和81．0％、64．0％、54．9％（χ^2=2．31，P=0．128），总生存率分别为84．4％、52．9％、45．6％与75．2％、50．7％、37．0％（χ^2=1．57，P=0．210）；亚组分析显示同期放化疗高于单纯放疗的有大体肿瘤长度〉7cm和N0期的局部控制率（χ^2=5．11和7．66，P=0．024和0．006）及N0期的生存率（χ^2=5．07，P=0．024）。白细胞、血小板、血红蛋白降低发生率分别为81．9％和49．0％（χ^2=36．45，P=0．000）、14．3％和1．9％（χ^2=10．54，P=0．006）、24．8％和2．9％（χ^2=22．95，P=0．000）；恶心、呕吐、便秘发生率分别为63．8％和7．7％（χ^2=71．52，P=0．000）；≥2级急性放射性食管炎发生率分别为48．6％和38．5％（χ^2=2．17，P=0．141），≥2级急性放射性肺炎发生率分别为15．2％和7．7％（χ^2=2．93，P=0．087）。结论食管癌同期放化疗与单纯放疗相比总生存率、局部控制率无显著提高，但N0期患者可能是明显获益人群，不良反应只有血液学和胃肠道反应明显不同，食管癌同期放化疗的价值有待进一步探讨。

Objective To observe the acute side effects, local control rate and survival rate of concurrent chemoradiotherapy （CC） and radiotherapy alone （R） for patients with esophageal carcinoma. Methods From June 2006 to February 2009, 209 patients with esophageal carcinoma were observed, 105 of them were treated with CC. Of all the patients, 117 received three-dimensional conformal radiotherapy, 92 received intensity modulated radiotherapy, the median prescription dose was 60 Gy. The regimen of LFP （5- FU, cisplatin and calcium folinate） was selected for this study, side effects, local control rate and survival rate were observed and subsets analysis were performed. Results The overall follow-up rate was 99. 0%, there were 99 and 44 patients whose follow-up time was more than 2 and 3 years, respectively;for the CC group, the data were 45 and 14, respectively;and for the R group, 54 and 30, respectively. The 1-,2-,3- year local control rates of CC group and R group were 88.1% ,69. 2% ,66. 2% and 81.0% ,64. 0% ,54. 9% （χ^2 =2. 31,P=0. 128）, respectively. The 1-,2-,3-year overall survival rates of CC group and R group were 84. 4% ,52. 9% ,45.6% and 75.2% , 50. 7% , 37.0% （χ^2= 1.57, P = 0. 210）, respectively. Subset analysis indicated that for the patients of No group and whose length of GTV 〉 7 cm, the local control rate of CC was significantly higher than that of radiotherapy alone （χ^2 = 5.11,7. 66 ; P = 0. 024, 0. 006）. For No group, the survival rate of CC was higher than that of R alone. （ χ^2 = 5. 07, P = 0. 024 ）. The incidence of WBC, PLT and HGB reduction for the two groups were 81.9% and 49. 0% （ χ^2= 36. 45, P = 0. 000）, 14. 3 % and 1.9% （ χ^2= 10. 54, P = 0. 006）, and 24. 8 % and 2. 9% （χ^2 = 22. 95,P = 0. 000）, respectively. The incidence of nausea, vomiting and constipation for the two groups were 63.8% and 7. 7% （χ^2 = 71.52, P =0. 000）, respectively. The incidence of/〉2 grade esophagitis of CC group and R group were 48. 57% and 38.46% （ χ^2 =2. 17 ,P =0. 141 ） , respectively. The incidence of ≥2 grade radiation pneumonitis of CC group and R group were 15.2 4 % and7.69 % （ 8/104 ） （ χ^2 = 2.9 3, P = 0.0 87 ）, respectively. Conclusions Compared to radiotherapy alone, the local control rate and overall survival rate of concurrent chemoradiotherapy were not improved significantly, the patients with NO may be the conspicuous beneficiary. About side effects, only mari＇ow depression and gastrointestinal tract reaction were significantly different between the two groups, the value of addition of concurrent chemoradiotherapy for esophageal carcinoma needs further investigation.