食管癌同期放化疗的临床观察

Concurrent chemotherapy for esophageal carcinoma treated with three-dimensional conformal radiotherapy

目的:观察中晚期食管癌同期放化疗与单纯放疗的毒副反应及疗效。方法:将中晚期食管癌患者155例分为同期放化疗组77例和单纯放疗组78例,两组患者均接受三维适形放疗或调强放疗,中位处方剂量均为60Gy。化疗方案为顺铂、5-FU和亚叶酸钙针,于放疗开始的第1、5周同期给予,观察患者治疗完成情况和急性毒副反应及生存率、局控率并进行亚组分析。结果:1)同期组白细胞、血小板、血色素减少情况均高于单放组,P<0.05。两组≥2级急性放射性食管炎发生率分别为51.95%(40/77)和24.36%(19/78),χ2=12.510,P=0.000,中重度急性放射性肺炎发生率分别为15.58%(12/77)和3.85%(3/78),χ2=6.108,P=0.013。2)同期组与单放组1、2、3和4年局控率和总生存率差异均无统计学意义,P>0.05。亚组分析未寻找到加入同期化疗后局控和生存获益的患者。3)局部控制失败仍然是患者死亡的主要原因,同期组与单放组死于远处转移患者的比率分别为28.6%(10/35)和32.6%(14/43),χ2=0.144,P=0.704。结论:食管癌精确放疗联合同期化疗有可能出现较重的毒副反应,患者总生存率、局控率及中位生存期有提高的趋势,但均未达统计学差异,临床价值需要进一步探讨。

OBJECTIVE：To observe the acute side effects and therapeutic effect of concurrent chemoradiotherapy and radiotherapy alone for patients with esophageal carcinoma.METHODS：Totally 155patients with esophageal carcinoma were observed for the concurrent control study,77of them were treated with concurrent chemoradiotherapy and 78of them received 3DCRT or IMRT alone.The median prescription dose for the two groups was both 60Gy.The regimen of LFP was selected for the concurrent chemoradiotherapy group,side effects,local control rate and survival rate were observed and subsets analysis were performed.RESULTS：The incidence of side effects in concurrent chemoradiotherapy group was higher than that of radiotherapy alone group（P〈0.05）.The incidence of≥2grade esophagitis were 51.95%（40 / 77） and 24.36%（19 / 78） for the two groups（χ ^2 = 12.510,P=0.000）.The incidence of severe radiation pneumonitis for the two groups were 15.58%（12 / 77） and 3.85%（3 / 78）,respectively（χ^ 2 =6.108,P=0.013）.2） The 1,2,3,4-year local control rates of concurrent chemoradiotherapy group and radiotherapy alone group were overall survival rates of the two groups.Subsets analysis did not find a subgroup which had a local or survival profit from the concurrent chemoradiotherapy.3） Local control failure were still the main cause of death,the ratio of patients died of metastasis was 28.6%（10 / 35） and 32.6%（14 / 43） in the concurrent chemoradiotherapy group and radiotherapy alone group respectively（χ ^2 =0.144,P=0.704）.CONCLUSIONS：The treatment of concurrent chemoradiotherapy may produce severe side effects.The local control rate,overall survival rate and median survival time of concurrent chemoradiotherapy are better,but there is no significant difference.The addition of concurrent chemotherapy for esophageal carcinoma need further investigate.