3DCRT联合周剂量顺铂治疗局部中晚期食管癌临床研究

The Clinical Study of 3-DCRT Combined with Weekly Cisplatin in Middle-to-Late Stage Esophageal Cancer

目的:探讨三维适形放射治疗(3-Dimensional Conformal Radiotherapy,3 DCRT)联合周剂量顺铂(DDP)与单纯3DCRT治疗局部中晚期食管癌的治疗效果及不良反应。方法:将168例局部中晚期食管癌患者随机分为两组,各84例。放化组:采用3DCRT联合每周一次DDP 25mg/m^2,静脉滴注,连续5次～6次;单放组:行单纯3DCRT治疗。结果:治疗结束后1月放化组及单放组食管片示Ⅰ级缓解率分别为57.1%及40.5%,两组差异有统计学意义(P<0.05),Ⅰ级+Ⅱ级缓解率分别为91.7%及77.4,两组差异有统计学意义(P<0.05);1年局部控制率放化组优于单放组(P<0.05),3年、5年局部控制率两组差异均无统计学意义(P>0.05);5年生存率放化组高于单放组(P<0.05);放化组及单放组死于远处转移分别为10例及25例(P<0.05);放化组及单放组死于局部未控分别为38例及37例(P>0.05);≥Ⅱ级的急性反应及后期并发症两组差异无统计学意义(P>0.05)。结论:3DCRT联合DDP治疗局部中晚期食管癌具有协同作用,具有较好的疗效,可提高肿瘤局部控制率和5年生存率,降低远处转移率。

Objective： To compare the therapeutic effects and adverse reactions of 3-Dimensional Conformal Radiotherapy （3DCRT） plus weekly cisplatin with those of 3DCRT alone in locally middle-to-late stage esophageal cancer. Methods： One hundred and sixty-eight patients with locally middle-to-late stage esophageal cancer were randomly assigned into two groups. In radiochemothera- py group（84cases） , 3DCRT plus weekly intravenous eisplatin at the dose of 25mg/m^2 for consecutive 5 -6 weeks were given to patients. In radiotherepy group（84eases） , patients received 3DCRT alone. Results： Esophageal barium X-ray taken one month after treatment showed that the grade I remission rate of radiochemotherapy group and radiotherepy group was 57. 1% and 40. 5 % respectively with significant difference（ P 〈 0. 05 ）. The radiochemotherapy group showed significantly higher grade I ＋ II remission rate compa- ring with radiotherapy group（ 91.7% vs. 77.4% , P 〈 0. 05 ）. The 1-year local control rate was significantly higher in radiochemotherapy group comparing with radiotherapy group（ P 〈 0. 05 ） , but both the 3-year and 5-year local control rate showed no significant differ- enee between these two groups（ P 〉 0. 05 ）. The 5-year survival rate in trial group was significantly higher than in control group （P 〈 0. 05 ）. Ten paitents in radiochemotherapy group and 25 patients in radiotherapy group died of distant metastasis （ P 〈 0. 05 ）. Thirty- eight paitents in radiochemotherapy group and 37 patients in radiotherapy group died of failure of local control（ P 〉 0. 05 ）. Conclusion： 3DCRT combined with eisplatin showed synergistic effect in treating locally middle-to-late stage esophageal cancer with better effects. It can also improve local control rate and 5-years survival rate and decrease distant metastasis rate.