放疗联合紫杉醇奈达铂同期化疗治疗食管癌的临床分析

Clinical analysis of radiotherapy combined with paclitaxel and nedaplatin for esophageal carcinoma

目的:评价同期放化疗治疗无法手术食管癌的近期、远期疗效及毒副反应。方法:回顾性分析我院2007年5月-2009年7月的150例患者,其中80例接受单纯放疗(RT),70例接受放疗联合紫杉醇及奈达铂化疗(RCT)。放疗前9天开始TP方案化疗(紫杉醇70mg/m2,d1,8;奈达铂20mg/m2,d1-4),21天为一周期,放疗前后共计化疗4周期。结果:治疗结束后7个月,同期放化疗组完全缓解率明显高于单纯放疗组(64.29%vs 42.5%,χ2=7.11,P=0.008),同期放化疗与单纯放疗的临床有效率分别为87.14%和73.75%(χ2=4.19,P=0.04)。1、2、3年局部控制率同期放化疗分别为75.71%、67.14%、37.14%;单纯放疗组为67.50%、48.75%、22.50%;两组患者2、3年局部控制率差异有统计学意义。同期放化疗患者1、2、3年生存率分别为68.57%、38.57%、31.45%,而单纯放疗组的1、2、3年生存率分别为53.75%、32.50%、15.0%,两组患者3年生存率差异有统计学意义(χ2=5.75,P=0.02)。同期放化疗组骨髓抑制及放射性食管炎反应较单纯放疗组明显,两组差异有统计学意义(P<0.05)。结论:放疗同期联合紫杉醇奈达铂化疗治疗不能手术的食管癌近期疗效及局部控制率较好,可提高远期生存率,但毒副反应较明显,有待临床进一步研究。

Objective：To evaluate the effect and toxicity of radiotherapy with concurrent paclitaxel and nedaplatin for esophageal carcinoma patients. Methods： Between May 2007 and July 2009,150 cases with histologically diag- nosed esophageal squamous carcinoma were enrolled. Of these patients, 80 cases with radiotherapy （ RT）, 70 cases with radiotherapy concurrent paclitaxel and nadaplatin （RCT）. 9 days before radiotherapy, the radiochemotherapy group received paclitaxel and nadaplatin（ paclitaxel 70mg/m2, dI and ds ; nadaplatin 20mg/m2, d1-4 ） on day 1 and day 22. Results ：7 months after treatments, the complete remission rate in RCT group（64.29% ） and RT group （42.50%） showed a significant difference. The overall response rate in RCT group （87.14%） was much higher than in RT group （73.75%）. The 1 - , 2 - , 3 - year local control rates in group RCT were 75.71% ,67.14% and 37.14% ,while in group RT,were 67.50% ,48.75% and 22.50% respectively. There was statistical significant differences in 2 - ,3 - year local control rates. The 1 - , 2 - , 3 - year survival rate in group RCT were 68.57% , 38.57% and 31.45% ,while in group RT,were 53. 750/0,32.50% and 15.0% respectively. There was significant differences in 3 - year survival time. The marrow toxic effect and the incidences of radiation - induced esophagitis were higher in RCT group （ P 〈 0.05 ）. Conclusion： Radiotherapy combined with paclitaxel and nedaplatin may have the potential of improving the overall response rate and survival rate of unresectable esophageal cancer. However, it can also increase toxic effects.