调强放疗联合多西他赛和顺铂化疗并卡培他滨维持治疗中晚期食管癌的临床观察

Effect of intensity-modulated radiotherapy combined with docetaxel and cisplatin and capecitabine continuous maintenance in treatment of patients with esophageal carcinoma

目的评价调强放疗联合多西他赛和顺铂同期化疗并卡培他滨维持治疗中晚期食管癌的临床疗效和安全性。方法 46例Ⅲ/Ⅳ期的中晚期食管癌患者根据入选标准随机分成调强放疗联合多西他赛和顺铂化疗并卡培他滨维持治疗(治疗组)和调强放疗联合多西他赛和顺铂化疗(对照组),每组23例,治疗组在放疗第1天同时给予多西他赛75mg/m2,第1天静脉滴注,顺铂25mg/m2,第1～3天静脉滴注,21d为1个周期,直至放疗结束后行卡培他滨维持治疗;对照组在放疗的同时联合多西他赛和顺铂化疗。两组放疗方法相同,采用X线和CT检查比较两组疗效,并且比较两组间毒副反应的差别。结果治疗组与对照组完全缓解率(CR)分别为56.5%和47.8%,有效率(CR+PR)分别为91.30%和82.61%,差异无统计学意义。中位生存时间(OS)分别为22.9个月和18.2个月,中位无进展生存期(PFS)分别为11.7个月和9.5个月,两组有统计学差异(P≤0.001)。治疗组1、2、3年生存率分别为82.6%、47.8%和21.7%,对照组1、2、3年生存率分别为60.9%、30.4%和13.0%,两组有统计学差异(P≤0.001)。毒性反应方面,对照组Ⅱ～Ⅲ度的放射性食管炎、胃肠道反应较治疗组严重(P<0.05)。结论调强放疗联合多西他赛和顺铂同期化疗并卡培他滨维持治疗较单纯调强放疗联合多西他赛和顺铂化疗疗效好,可提高中晚期食管癌的有效率、局部控制率,延长生存期,提高生活质量,且毒副反应患者均能耐受。

Objective To evaluate the clinical efficacy and safely of concurrent intensity-modulated radiotherapy combined with docetaxel and cisplatin and capecitabine continuous maintenance in treatment of patients with esophageal carcinoma.Methods 46 patients with locally advanced esophageal cancer were randomly divided into the treatment group （23 patients） and the control group （23 patients）.The treatment group were given docetaxel 75 mg/m2 infusion d1,DDP 25 mg/m2 from d1 to d3 and capecitabiné continuous maintenance.The control group were given docetaxel and cisplatin.The radiotherapy was the same in the two groups.Results The response rate and complete response in the treatment group were significantly higher than those in the control group.The acute toxic effect was severer in the treatment group than in the control group.Conclusions The intensity-modulated radiotherapy concurrently combined with docetaxel and cisplatin and capecitabine continuous for patients with inoperable esophageal cancer is more effective,and lower toxicity,the patients could tolerate the side effects.