食管癌适形调强放射治疗同步化疗的临床疗效观察

Clinical observation of radiochemotherapy in esophageal cancer

目的探讨局部晚期非手术食管癌患者同步放化疗后的近期疗效、生存率及毒副反应。方法选择未行手术的局部晚期食管癌患者108例,将其分为同步放化疗组（n=66例）和单纯放疗组（n=42例）。采用以铂类为基础的化疗方案：顺铂25~30 mg/m2（第1~2天）＋氟尿嘧啶500 mg（第1~5天）＋亚叶酸钙300 mg（第1~5天）静点1个周期,或单药氟尿嘧啶500 mg放疗期间静点。放疗方案为：食管病变部位适形调强放射治疗（intensity modulated radiation therapy）,总剂量为50~66 Gy。治疗结束后对两组的疗效和不良反应进行分析比较。结果同步放化疗组与单纯放疗组的治疗有效率分别为90.9%和71.4%（P=0.025）,两组转移复发率分别为48.5%和52.4%（χ2=1.330,P=0.722）,两组的1、2、3年生存率分别为83.9%、62.5%、46.4%和63.5%、50.1%、42%（χ2=1.697,P=0.193）。两组均无严重的3~4级放射性食管反应及Ⅳ度血液毒副反应的发生。同步放化疗组中2种化疗方案的近期疗效、转移复发率及生存率比较差异均无统计学意义（P〉0.05）。单因素分析结果显示,近期疗效与有无复发转移是生存期的影响因素。多因素分析显示,治疗方式、近期疗效及有无转移复发为影响生存的因素。结论对于局部晚期食管癌患者,同步放化疗的近期疗效好于单纯放射治疗,同步放化疗和单纯放射治疗均无严重不良反应。治疗方式、近期疗效及有无复发转移是其预后影响因素。

Objective To discuss the recent curative effect,survival rate and side reaction to the radioche-motherapy in locally advanced esophageal cancer.Methods 108 patients with the locally advanced esopha-geal cancer were randomly divided into two groups：66 patients were distributed in the concurrent radio-chemotherapy group,treated with concurrent radiotherapy and chemotherapy;the other 42 patients in the radiotherapy group,treated only with radiotherapy.The chemotherapy was based on cisplatin：20 -30 mg/m2 ＆#183;d cisplatin ivgtt on day 1-2,and fluorouracil 500 mg ivgtt on day 1-5 and calcium folinate 300mg ivgtt on day 1-5,or fluorouracil only.The radiotherapy was intensity modulated radiation therapy （IMRT）,with 50-66 Gy e radiotherapy dosage.Observe the therapeutic effect and toxic and side effect of the two groups after the treatment.Results The effective rate was 90.9% in the concurrent radiochemo-therapy group,and was 71.4% in the radiotherapy group.The 1 year,2 year and 3 year survival rates were 83.9%,62.5%,46.4% in the concurrent radiochemotherapy group,and were 63.5%,50.1%,42% in the＆amp;nbsp;radiotherapy group.The transfer and the recurrence rate in the concurrent radiochemotherapy group were 48.5%,and 52.4% in the radiotherapy group.Conclusions The concurrent radiochemotherapy had better curative effect on locally advanced esophageal cancer than radiotherapy,without increasing the serious ad-verse reaction.The different treatments,the recent curative effects and presence of metastasis were the factors affecting prognosis.