中晚期食管癌同步放化疗与序贯性放化疗疗效对比

Outcome comparison of concurrent and sequential chemoradiotherapy for advanced stage esophageal cancer

目的：分析中晚期食管癌行同步放化疗与序贯性放化疗的临床疗效。方法：以171例2008年5月至2012年5月连云港市第二人民医院病理诊断为中晚期食管癌的患者为研究对象,将患者随机分为2组,同步放化疗组和序贯放化疗组,两组均采用2Gy/次,总量56~64Gy的三维适形放疗以及以铂类为基础的两联方案化疗。治疗结束评价并对比患者的近期疗效、生存预后以及毒副反应。结果：食管恶性肿瘤患者171例,其中同步放化疗组86例,序贯放化疗组85例,近期疗效的比较,差异无统计学意义（P〉0.05）;1、2、3年生存率经Logrank检验,两组生存率有显著性差异（P=0.000）,同步放化疗1、2、3年的生存率显著高于序贯放化疗。汉族组的生存率均高于少数民族组,但是同步放化疗组不同民族比较,无显著性差异（P〉0.05）。汉族及少数民族患者比较,同步放化疗均优于序贯放化疗,有显著性差异（P均〈0.05）。两组患者均出现不同程度放射性食管炎、血液学毒性及恶心、呕吐等反应。同步放化疗组的毒副反应发生率均高于序贯放化疗组,白细胞下降发生率、恶心、呕吐发生率比较,差异有统计学意义（P〈0.05）;放射性食管炎的发生率比较,差异有统计学意义（P〉0.05）。结论：同步放化疗较序贯放化疗可明显提高中晚期食管癌的远期生存率,不同民族间疗效存在差异,毒副反应可耐受。

Objective：To analyze the clinical efficacy of patients with advanced esophageal cancer treated by concurrent chemoradiotherapy and sequential chemoradiotherapy. Methods-All 171 patients with advanced esophageal cancer from May 2008 to May 2012 were selected and were randomly divided into two groups,concurrent chemoradiotherapy group（ 86 cases） and sequential chemoradiation group （85 cases）. All patients sunderwent radiation therapy with 2Gy per fraction and total dose of （56 -64）Gy/（28 - 32）f with three -dimensional conformal radiotherapy and platinum -based chemotherapy. Results：A total of 171 esophageal cancer patients were collected including concurrent chemoradiotherapy group 86 patients, sequential chemoradiotherapy group 85 cases. Relatively short - term effect in 2 groups,P 〉 0.05.1,2,3 - year survival rates P = 0. 000, in two groups survival rates were significantly different. In concurrent chemoradiotherapy group 1,2,3 - year survival rate was significantly higher than sequential chemoradiotherapy. Survival rates for both groups of Han were higher than the minority group, but synchronous radiotherapy and chemotherapy group P 〉 0.05. Patients in both groups experienced varying degrees of esophagitis, hematologic toxicity and reactivity, nausea, vomiting and other side effects. Conclusion：Concurrent chemoradiotherapy compared With sequential chemoradiotherapy for advanced esophageal cancer can significantly improve long - term survival, toxicity can be tolerated.