食管鳞癌的放射治疗加TP方案化疗综合治疗86例分析

Clinical analysis of radiotherapy combined with TP regimen chemotherapy in treating 86 cases of esophageal squamous carcinoma

目的探讨紫杉醇与顺铂同步化疗联合放疗对食管癌的可行性和近期疗效。方法对126例食管鳞癌患者进行前瞻随机分组研究，其中单纯放疗组40例，放化同步治疗综合组86例。放疗采用常规分割方式，总剂量50～64Gy，放化疗同步治疗组在上述放疗的同时加用化疗，化疗采用TP方案。计算2组总生存率、放化疗毒副反应，以及死亡原因分析。结果放化疗组和单纯放疗组的1年生存率分别为76．7％和71．8％。同期放化疗可提高KPS评分90、N1期亚组的1年生存率。放化疗同步治疗组Ⅲ～Ⅳ级骨髓抑制、食管炎发生率高于单纯放疗组，但差异无统计学意义，其他急性毒副反应、晚期副反应发生率相似。2组的局部复发率分别为48．8％、66．7％，远处转移率分别为16．3％、12．8％。结论同期放化疗可提高患者总生存率、KPS评分90和N1期亚组的生存率，降低区域失败率，但未能降低远处转移率，且Ⅲ～Ⅳ级骨髓抑制、急性食管炎发生率增加。

Objective To investigate the feasibility and recent efficacy of radiotherapy com- bined with concurrent chemotherapy of paclitaxel and cisplatin in treating esophageal cancer. Meth- ods 126 patients with esophageal squamous cell were randomly divided into 2groups based on prospective analysis, in which radiotherapy group included 40 cases, and radiochemical resynchro- nization therapy group included 86 cases. Conventional fractionation was used in radiotherapy, and the total dose was from 50 to 64 Gy. At the same time, TP regimen of radiation therapy was given. The total survival rate, toxic and side effects of radiotherapy and chemotherapy as well as causes of death were analyzed. Results 1 year survival rates in group of radiotherapy and chemotherapy and group of simple radiotherapy were 76.7% and 71.8% respectively. Concurrent chemotherapy and radiotherapy were able to improve KPS score by 90 and 1 year survival rate of N1 sub - group. The incidence rates of Ⅲ～Ⅳ bone marrow suppression and esophagitis in concurrent chemoradiotherapy treatment group were higher than those of simple radiotherapy group, but the difference had no sta- tistical significance. The incidence rates of acute toxicity and side effects were similar. Local recur- rence rates of both groups were 48.8% and 66.7%, and distant metastasis rates were 16.3% and 12.8 %, respectively. Conclusion Concurrent chemoradiotherapy can improve the overall survival rate, KPS score by 90 and N1 subgroup survival rate, and reduce regional failure rate. However, it fails to reduce the rate of distant metastasis, and increase the incidences of Ⅲ～Ⅳ bone marrow suppression and acute esophagitis.