调强放射治疗联合周剂量紫杉醇治疗食管癌的临床研究

Clinical research on Paclitaxel chemotherapy combined with intensity modulated radiation therapy(IMRT) in the treatment of esophageal carcinoma

目的探讨紫杉醇单药同步调强放疗治疗食管癌的近期疗效、局部控制率、生存率及毒性反应。方法 103例食管癌患者根据入选标准分为两组,60例进入调强放疗＋紫杉醇组（放化疗组）,43例进入单纯调强放疗组（单放组）。单放组采用调强放疗,95%计划靶体积（planning target volume,PTV）：66 Gy/30~33次,每周5次;放化疗组：放疗从第1天即开始采用调强放射治疗,同时化疗（紫杉醇30 mg）,第1、8、15、22、29、36天静脉滴注。结果放化疗组食管癌病灶近期总有效率为83.3%,单放组为60.4%,两组比较差异有统计学意义（P〈0.05）。单放组1、2年生存率分别为55.8%（24/43）、32.5%（14/43）,放化疗组为86.6%（52/60）、68.3%（41/60）,两组比较差异有统计学意义（P〈0.05）。毒副反应放化疗组稍高于单放组,但差异无统计学意义（P〉0.05）。结论紫杉醇单药每周方案同步调强放疗治疗食管癌近期疗效和局部控制率较好,能提高远期生存率,虽毒性反应增加但能耐受。

Objective To evaluate the short-term efficacy,local control rate,survival rate and toxicity of concurrent Paclitaxel chemotherapy combined with IMRT in the treatment of esophageal carcinoma.Methods 103 esophageal carcinoma patients were divided into two groups randomly,60 cases were treated with concurrent IMRT and Paclitaxel chemotherapy（chemo-radiation group）;another 43 cases were treated with radiotherapy only（radiotherapy group）.All patients were irradiated by planning target volume（PTV） 95%,five fractions a week,the total radiation dose was 66 Gy/30-33 times in tumor.Besides,the chemo-radiation group was also received the concurrent chemotherapy with 30 mg of Paclitaxel on the 1st,8th,15th,22nd,29th,36th day when radiation.Results The chemo-radiation group was more effective than radiotherapy group（83.3% vs 60.4%）,and there was significant difference between the two groups（P 0.05）.1,2-year survival rates of chemo-radiation group and radiation group were 86.6%,68.3% and 55.8%,32.5% respectively,and there was significant difference between the two groups（P 0.05）.And there was no significant difference of toxicity effects between the two groups（P 0.05）.Conclusion Concurrent Paclitaxel chemotherapy and intensity modulated radiation therapy（IMRT） for esophageal carcinoma can improve the short-term efficacy and local control rate,and hence improve the long-term survival rate with lightly higher and tolerable toxicity.