食管癌再程放疗的临床观察

Clinical observation of esophageal cancer re-course radiotherapy

目的探讨食管癌放疗后局部复发再程放疗的治疗价值,并分析再程放疗及放疗联合化疗的疗效和不良反应。方法采用回顾性分析方法,对开封市中心医院2005-05-18-2010-05-21收治的41例食管癌患者,分为单纯再程放疗组20例及化疗联合再程放疗组21例,对其疗效、不良反应等进行比较。结果单纯再程放疗组有效率(RR)为45.00%(9/20),化疗联合再程放疗组为85.71%(18/21),差异有统计学意义,χ2=8.25,P=0.035。单纯再程放疗组1年生存率为45.00%(9/20),2年为25.00%(5/20),3年为10.00%(2/20);化疗联合再程放疗组1年生存率为52.38%(11/21),2年为28.57%(6/21),3年为14.29%(3/21);2组差异无统计学意义,χ2=0.05,P=0.975。单纯再程放疗组急性放射性食管炎发生率为75.00%(15/20),≥2级者为45.00%(9/20);化疗联合再程放疗组则分别为90.45%(19/21)和52.39%(11/21);2组差异无统计学意义,z=-0.877,P=0.380。单纯再程放疗组急性放射性肺炎发生率为20.00%(4/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为23.81%(5/21)和9.52%(2/21);2组差异无统计学意义,z=-0.361,P=0.718。单纯再程放疗组骨髓抑制发生率为45.00%(9/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为57.14%(12/21)和23.81%(5/21);2组差异无统计学意义,z=-1.228,P=0.220。结论食管癌放疗后局部复发再程放疗仍是有效治疗的手段,联合化疗是可行的,并能提高治疗效果,不良反应可耐受。

OBJECTIVE To research the value of re-course radiotherapy for local recurrence of esophageal cancer after radiotherapy, and analyze the curative effect and adverse reactions of re-course radiotherapy and radiotherapy combined with chemotherapy. METHODS The curative effect and adverse reactions of 20 patients with re-course radiotherapy and 21 patients with radiotherapy combined with chemotherapy were compared retrospectively. RESULTS The RR of recurrence in the re-course radiotherapy group was 45.00% （9/20）, while 85. 71%（18/21） in the radiotherapy combined with chemotherapy. There was statistically difference between the two groups （X2= 8. 25, P= 0. 035）. The 1-,2- and 3-year survival rates were 45. 00% （9/20）, 25. 00%（5/20） and 10. 00% （2/20） in the simple re-course radiotherapy gro up, while 52.38 % （ 11 / 21 ）, 28.57 % （6 / 21 ）, 14.29% （3 / 21 ） in the gro up of radiotherapy combined with chemotherapy. There was not statistically difference between the two groups （X2 = 0.05 ,P=0. 975）. Both treatment types were well-tolerated. As for adverse reactions, the acute radiation-induced esophagitis rate in the re-course radiotherapy group was 75.00% （15/20）,in which ≥Grade 2 was 45.00% （9/20）, and 90.45% （13/20） in the group of radiotherapy combined with chemotherapy, in which ≥ Grade 2 was 52. 39 % （ 11/21 ）. There was not statistically difference between the two groups （z=-0. 877, P= 0. 380）. In addition, the acute radiation-induced pneumonitis rate was 20.00 % （4/20）, in which ≥Grade 2 was 5.00% （1/20）,and 23.81% （5/21）, in which ≥Grade 2 was 45.00% （9/20）. There was not statistically difference between the two groups （z = - 0.361, P = 0.718）. Moreover, the myelosuppression rate was 9.52 % （2/21 ）, in which ≥Grade 2 was 5.00%（1/20） ,and 57.14%（12/21） ,in which ≥Grade 2 was 23.81%（5/20）. There was not statistically difference between the two groups （z =- 1. 228, P = 0. 220）. CONCLUSIONS Re-course radiotherapy is an effective treatment for local recurrences of esophageal cancer, and can be used in combination with chemotherapy to improve the treatment. Adverse reactions of both treatment forms were minimal.