食管癌患者三维适形放疗联合化疗的疗效分析

The Effect of Combination of Three Dimensional Conformal Radiotherapy with Chemotherapy in the Treatment of Esophageal Cancer

[目的]分析联合化疗对食管癌三维适形放疗(3D-CRT)疗效的影响。[方法]回顾性分析351例经病理确诊的食管癌患者临床资料,其中258例接受3D-CRT,93例接受3D-CRT联合化疗,比较这两种方法对食管癌的治疗效果。全组总放疗剂量40～72Gy,中位剂量66Gy,常规分割。3D-CRT联合化疗组放疗期间接受PF方案化疗2个周期,部分患者再接受1～2个周期PF方案辅助化疗。[结果]3D-CRT联合化疗组和3D-CRT组的1、2、3年总生存率分别为77.7%、55.4%、44.4%和68.4%、41.4%、32.7%(χ2=5.777,P=0.016),1、2、3年疾病相关生存率分别为79.8%、58.1%、46.5%和70.6%、44.4%、36.0%(χ2=4.445,P=0.035),1、2、3年无复发生存率分别为66.9%、48.3%、41.3%和57.6%、36.9%、29.9%(χ2=4.043,P=0.044)。单因素和因素分析均显示性别、病灶部位和联合化疗是影响预后的重要因素。3D-CRT联合化疗组治疗急性毒性高于3D-CRT组,但均不影响治疗进程,无治疗相关性死亡。[结论]联合化疗能显著提高食管癌患者3D-CRT的总生存率、疾病相关生存率和无复发生存率。女性患者、病灶位于颈段或胸上段和接受联合化疗者有较好的预后。

[Purpose] To evaluate the impact of chemotherapy on patients with esophageal cancer who received 3D-conformal radiation therapy（3D-CRT） .[Methods] A retrospective analysis was conducted to the clinical data of 351 patients pathologically confirmed with esophageal cancer.Two hundred and fifty eight cases received 3D-CRT alone and 93 received 3D-CRT combined chemotherapy.Radiation dosage ranged from 40 to 72Gy（median 66Gy） with conventional fractionation.The 3D-CRT combined chemotherapy group received two cycles of cisplatin-based concurrent chemotherapy,and 40 patients in this group received one or two additional cycles of adjuvant chemotherapy.[Results] The 1,2,3-year overall survival rates for patients in 3D-CRT combined chemotherapy group were 77.7%,55.4%,44.4% respectively;while the 3D-CRT alone group had rates of 68.4%,41.4%,32.7%（χ2=5.777,P=0.016） respectively.The 1,2,3-year disease specific survival rates were 79.8%,58.1%,46.5% for the 3D-CRT combined chemotherapy group and 70.6%,44.4% and 36.0% for the 3D-CRT group（χ2=4.445,P=0.035）;and the recurrence free survival rates were 66.9%,48.3%,41.3% and 57.6%,36.9%,29.9%,respectively（χ2=4.043,P=0.044） .Independent factors predictive of better survival by multivariate analyses showed that the female gender,having a primary tumor located in neck or upper thoracic,and having been treated with concomitant chemotherapy were the main factors.Compared with those in 3D-CRT group,patients in 3D-CRT combined chemotherapy group had more acute toxicities.However,no fatal side effect was observed.[Conclusion] The addition of concomitant chemotherapy in 3D-comformal radiation therapy for esophageal cancer has a statistically significant positive impact on overall survival,disease-specific survival and recurrence-free survival rates.Female patients,primary tumor located in neck or upper thoracic and patients treated with combination chemotherapy maybe have a better prognosis.