放疗联合卡培他滨治疗老年食管癌

Clinical observation of intensity modulated radiation therapy combined with capecitabine for elder esophageal cancer

目的观察调强放疗联合卡培他滨治疗老年食管癌的疗效和毒副反应。方法将69例不能手术或不同意手术的中晚期食管癌患者随机分为观察组35例和对照组34例。观察组采用调强放疗同步希罗达化疗：口服卡培他滨1000mg/m2,2次/天,连用14天后停药7天,21天为1周期,共2周期。对照组单纯调强放疗。两组放疗均采用常规分割,总剂量DT60～66GY/30～33/6～7W。治疗结束4周后比较两组的近期疗效及毒副反应,随访两组的1、2、3年生存率。结果观察组与对照组总有效率（CR＋PR）分别为85.7%和64.7%（P〈0.05）,1年生存率分别为80%和55.9%（P〈0.05）,2年生存率分别51.4%和37.1%（P＞0.05）,3年生存率分别为31.4%和23.5%（P＞0.05）,不良反应主要表现为放射性食管炎和骨髓抑制、放射性肺炎、消化道症状、手足综合征,多为Ⅰ、Ⅱ级,无统计学差异（P＞0.05）。结论调强放疗联合希罗达治疗中晚期食管癌可显著提高老年患者的局部控制率和近期疗效,副反应轻,但对2、3年生存率无影响。

Objective To evaluate the therapeutic efficacy and toxicity of IMRT combined with capecitabine for elder patients with advanced esophageal cancer.Methods 69 patients with advanced esophageal cancer were randomly divided into two groups.35 cases in the experimental group received IMRT combined with capecitabine.34 cases in the control group received IMRT alone.Radiotherapy was given with conventional fraction.The total tumor does were 60-66GY/30-33F/6-7W.ResultsThe overall response（CR ＋ PR）rates for the treatment group and the control group were85.7% and 64.7 %（P〈0.05）,respectively.The one- year survival rates for the treatment group and the control group were 80% and 55.9%（P〈0.05）.The three-year survival rates for the treatment group and the control group were 31.4% and 23.5%（P〉0.05）.The adverse reaction manifested mainly were radiation esophagitis,bone marrow suppression,radiation pneumonitis,digestive tract reaction and hand-foot syndrome.Conclusion IMRT combined with capecitabine for elder patients withadvanced esophageal cancer could significantly improve the local control rate and recent effective near-term rate and have slight side effec.