替吉奥同期放射治疗局部晚期老年人食管癌的临床观察

Clinical observation of concurrent radiotherapy combined with S-1 for elderly patients with locally advanced esophageal cancer

目的 探讨替吉奥同期放射治疗局部晚期老年人食管癌的临床疗效和不良反应.方法 选择2011年1月至2013年4月收治的50例局部晚期老年食管癌患者,按信封法随机分为替吉奥同期放疗组（治疗组）25例和单纯放疗组（对照组）25例.两组均采用调强放疗,常规分割,处方剂量均为58～60 Gy,分29～30次给予.治疗组在放疗开始时口服替吉奥胶囊（每天80 mg/m2,2次/d）,连服14 d,21d为1个周期,直至放疗结束.结果 47例患者可评价疗效.治疗组完全缓解（CR）5例,部分缓解（PR） 14例,稳定（SD）3例,进展（PD）1例,有效率（RR）为82.6％（19/23）;对照组CR 3例,PR12例,SD 6例,PD 3例,RR为62.5 ％（15/24）;两组RR差异有统计学意义（P＜0.05）.治疗组和对照组1年局部控制率分别为63.6％和43.5％,1年生存率分别为68.2％和39.1％,两组差异均有统计学意义（均P＜0.05）.不良反应主要为骨髓抑制、胃肠道反应、放射性食管炎、放射性肺炎等,两组不良反应发生率差异均无统计学意义（均P＞0.05）.治疗组骨髓抑制和胃肠道反应发生率稍高于对照组,症状轻微且能耐受,经对症处理后均能完成治疗.结论 替吉奥同期放射治疗局部晚期老年人食管癌近期疗效较好,不良反应可以耐受,值得进一步研究.

Objective To evaluate the clinical effects and adverse reactions of concurrent radiotherapy combined with S-1 for elderly patients with locally advanced esophageal cancer.Methods From January 2011 to April 2013,a total number of 50 elderly patients with locally advanced esophageal carcinoma were randomly divided into concurrent chemo-radiotherapy combined with S-1 group （treatment group） （25 cases） and radiotherapy alone group （control group） （25 cases）.Intensity modulated radiation therapy （IMRT） was administered in all cases,with a total dose of （58-60） Gy/（29-30） fx,conventional fractionation.Patients in the treatment group received S-1 of 80 mg/m2 orally bid on day 1-14,with 21 days as a cycle.All the patients should take it until the end of the radiotherapy treatment.Results The efficacy of the 47 cases could be evaluated.In treatment group,5 cases achieved CR,14 cases PR,3 cases SD,1 case PD.The response rate （RR） was 82.6 ％ （19/23）.In control group,3 cases achieved CR,12 cases PR,6 cases SD,3 cases PD.The RR was 62.5 ％ （15/24）.There was a statistical significant difference between the two groups.The one-year local control rates of treatment group and control group were 63.6 ％ and 43.5 ％,respectively,and the one-year overall survival rates were 68.2 ％ and 39.1％,respectively.The main toxicities included bone-marrow suppression,gastrointestinal reactions,radiation esophagitis and radiation pneumonitis.The incidences of bone-marrow suppression and gastrointestinal reactions were higher in treatment group than those in control group,but the toxic reaction was mild and tolerable.There were no significant differences in terms of bone-marrow suppression,gastrointestinal reactions,radiation esophagitis and radiation pneumonitis between both groups.Conclusion Concurrent chemotherapy combined with S-1 is more effective in the treatment of the elderly patients with locally advanced esophageal cancer and the toxicity is tolerable,which is worth studying furtherly.