三种治疗模式治疗中晚期食管癌疗效分析

Effect analysis of three treatment model for mid-term and advanced stage esophageal cancer

目的评价三种治疗模式对中晚期食管癌的临床疗效和毒副作用。方法对近4年我院收治的中晚期食管癌采用3种治疗模式（同步放化疗组、序贯放化疗组、单纯放疗组）的疗效进行分析。结果①近期有效率（CR＋PR）：同步放化疗组为91．6％，高于序贯放化疗组（65．1％）和单纯放疗组（46．1％），三组比较差异有统计学意义（x2=4．20，x2=5．20，x2=5．28，均P〈0．05）；②远期疗效：1年生存率：同步放化疗组（83．3％），高于序贯放化疗组（74．4％）和单纯放疗组（69．2％），但差异无统计学意义（P均〉0．05）。2年生存率：同步放化疗组（50．0％）高于序贯放化疗组（41．8％）和单纯放疗组（20．5％）。同步放化疗组与序贯放化疗组比较差异无统计学意义（P〉0．05），但同步放化疗组与序贯放化疗组明显高于单纯放疗组（x2=4．20，x2=4．10，P〈0．05）；③毒副作用：同步放化疗组、序贯放化疗组的骨髓抑制、食管炎、放射性肺炎和恶心、呕吐发生率均高于单纯放疗组（P均〈0．05），而同步放化疗组与序贯放化疗纽比较差异无统计学意义（P〉0．05）。结论同步放化疗组治疗局部晚期食管癌疗效优于序贯放化疗组及单纯放疗组。虽不良反应增多，但多数患者可以耐受。

Objective To evaluate the clinical efficiency and side effects of concurrent chemoradiotherapy, sequential chemoradiotherapy and radiotherapy for mid-term and advanced stage esophageal cancer, Methods The middle-advanced stage esophageal cancer patients received concurrent chemoradiotherapy, sequential chemoradiotherapy and radiotherapy in the recent the four years, and the effects were analyzed. Results （1）The short-term effective rate was 91.6% in concurrent chemoradiotherapy group, 65. 1% in sequential chemoradiotherapy, and 46. 1% in radiotherapy, there were significant differences （ x2 = 4. 20, X2 = 5.20, x2 = 5.28, P 〈 0. 05 ）. （2）Long-term efficacies （ CR ＋ PR） ： 1 year survival rate in concurrent group （83.3%） was higher than that in sequential group （74. 4% ） and mere radiotherapy group （69. 2% ）, but there were no significant differences among these therapeutic models （P 〉 0. 05 ）. Two years survival rate was higher in concurrent group （50. 0% ） than that in sequential group （41.8%） and mere radiotherapy group （20. 5% ）. The concurrent group and sequential group had a higher 2 years survival rate than mere radiotherapy group （x2 = 4. 20, x2 = 4. 10, P 〈 0. 05 ）, although there was no significant difference between concurrent group and sequential group. （3）Toxic side effects： The concurrent and sequential group had higher toxic side effects such as myelosuppression, esophagitis, radiation pneumonia, nausea and vomiting than that of mere radiotherapy group （P 〈 0. 05 ）, while there was no significant difference between concurrent and sequential group （P 〉 0. 05 ）. Conclusions Concurrent chemoradiotherapy is more effective on mid-term and advanced stage esophageal cancer than sequential chemoradiotherapy and radiotherapy. Although with more adverse reactions, but they can be tolerated well by most patients.