替加氟卡铂同步放化综合治疗老年食管癌

Tegafur Combined with Carboplatin Concurrent Chemoradiation for the Elderly and Adult Esophagus Carcinoma

目的观察替加氟联合卡铂同步放化综合治疗老年食管癌的临床价值。方法收集90例60岁以上初治食管癌,同步放化组45例,单纯放疗组45例。采用钴-60常规分割放疗,总剂量60～66 Gy。采用替加氟500 mg/m2,第1～5 d+卡铂200 mg/m2,第1 d2、8 d为1周期。比较两组疗效、总生存率、毒副反应、失败原因。结果放化组的1、24、年生存率分别为68.9%(31/45)、51.1%(23/45)、30.0%(15/45);单放组的12、、4年生存率分别为53.3%(24/45)、35.6%(16/45)、15.6%(7/45)。同步放化疗组和单纯放疗组的恶心、呕吐、Ⅲ～Ⅳ级骨髓抑制发生率分别为66.7%、35.6%、35.6%和11.1%、6.7%、8.9%(χ2=29.2211、1.2759、.257,P=0.000、0.0010、.002)。同期放化疗组、单纯放疗组的局部复发率分别为44.4%和66.7%(χ2=4.500,P=0.034),远处转移率分别为17.8%和15.6%(χ2=0.080,P=0.777)。结论替加氟卡铂同步放化治疗老年食管癌较单纯放疗提高总生存率和局部控制率,但未能降低远处转移率,且胃肠道反应、Ⅲ～Ⅳ级骨髓抑制发生率显著增加。

Objective The aim of the study was to observe the clinical value of tegafur combined with carboplatin concurrent chemoradiation for the elderly and adult esophagus carcinoma.Methods 90 patients who were all above 60 years old were eligible for this study.45 patients were given concurrent radiochemotherapy（RCT） and all 45 patients were given radiotherapy alone（RT）.The overall survival rates,side effects and causes of failure between the two groups were compared.The regimen for chemotherapy was tegafur（500 mg/m2 on D1~D5） combined with carboplatin（200 mg/m2 on D1.A treatment cycle was 28 days.Total dose of irradiation which used by cobalt-60 ranged from 60~66 Gy.Results The 1-year,2-year,4-year survival rates in the RCT group were 68.9%（31/45）,51.1%（23/45）,30.0%（15/45） respectively.The 1-year,2-year,4-year survival rates in the RT group were 53.3%（24/45）,35.6%（16/45）,15.6%（7/45） respectively.Nausea,vomiting and grade Ⅲ~Ⅳ bone marrow depression were 66.7%,35.6%,35.6%% in the RCT group;and 11.1%,6.7%,8.9% in the RT group,respectively（χ2=29.221,11.275,9.257,P=0.000,0.001,0.002）.The other acute toxicities and late side effects have no significant difference between the two groups（P0.05）.The local fail was significant difference between the two group（44.4%： 66.7%,χ2=4.500,P=0.034,but nor significant difference was found in the distant metastases（17.8%： 15.6%,χ2=0.080,P=0.777）.Conclusion Compared with radiotherapy alone,concurrent radiochemotherapy could significantly improve the overall survival and local control of patients with the elderly and adult esophageal carcinoma but fails to reduce the distant mata stasis.Patients treated with Radiochemotherapy are likely to develop Nausea,Vomiting and grade Ⅲ~Ⅳ bone marrow depression.