后程同步放化疗治疗中晚期食管癌的疗效分析

Late-course and concurrent radiochemotherapy for advanced esophageal carcinoma

目的比较后程同步放化疗和序贯化放疗治疗中晚期食管癌的疗效及不良反应。方法将82例中晚期食管癌患者按治疗方法不同分为后程同步放化疔组（41例）与序贯化放疗组（41例），所有病例均以PFL方案化疗4个周期，具体方案：顺铂25mg／m^2，第1—3天，亚叶酸钙150mg／m^2，第1～5天，氟尿嘧啶375mg／m^2，第1～5天，21d为1个周期。两组放疗均采用三维适形照射，方法及剂量相同。后程同步放化疗组：先行2个周期化疗，再给2个周期化疗和放疗同步进行；序贯化放疗组：先行4个周期化疗后再给放疗。结果后程同步放化疗组的有效率为85．4％（35／41），高于序贯化放疗组的65．9％（27／41），差异有统计学意义（P〈0．05）；需要治疗的急性放射性食管炎的发生率，后程同步放化疔组[90．2％（37／41）]略高于序贯化放疗组[87．8％（36／41）]，但差异无统计学意义（P〉0．05）；两组1，2，3年生存率分别为68．3％（28／41）和65．9％（27／41）；56．1％（23／41）和51．2％（21／41）；46．3％（19／41）和36．6％（15／41），中位生存时间分别为30和26个月，差异无统计学意义（P〉0．05）。结论后程化疗同步放疗可提高中晚期食管癌的近期疗效。

Objective To compare the efficacy and toxicity of late-course concurrent radiochemotherapy and sequential chemoradiotherapy for advanced esophageal carcinoma. Methods Eighty-two patients with advanced esophageal carcinoma were randomized into two groups： 41 cases in late-course concurrent radioehemotherapy （LCRC） group were received two cycles chemotherapy and then underwent concurrent radiochemotherapy;41 cases in sequential chemoradiotherapy （SCR） group were received four cycles chemotherapy and then underwent radiotherapy. The regimen of chemotherapy in all cases： cisplatin 25mg/m^2, 1 - 3 d; calcium folinate （CF） 150 mg/m^2, 1 - 5 d; fluorouracil 375 mg/m^2, 1 - 5 d, 21 d was one cycle. All patients were received the three-dimensional conformal radiation therapy, the total dose of radiation was same as 64 Gy. Results The short-term response rate was 85.4%（35/41） in LCRC group and 65.9%（27/41） in SCR group, they had significant difference （P 〈 0.05）. The rates of acute radiation esophagitis that need treatment was 90.2%（37/41） in LCRC group and 87.8%（36/41） in SCR group, there had no significant difference （P 〉 0.05）. The 1 year, 2 years, 3 years survival rate were 68.3 % （28/41） and 65.9% （27/41）, 56.1%（23/41） and 51.2%（21/41）, 46.3%（19/41） and 36.6%（15/41） respectively,the median survival time were 30.0 months and 26.0 months, there had no significant difference （P 〉 0.05）. Conclusion The short-term efficacy of advanced esophageal carcinoma could be improved by the late-course concurrent radiochemotherapy.