奈达铂与替加氟同步化疗联合放疗治疗老年食管癌的疗效观察

Clinical observation of nedaplatin plus tegafur combined with radiotherapy for elderly patients with esophageal carcinoma

目的探讨奈达铂(NDP)与替加氟同步化疗联合放疗治疗老年食管癌的临床疗效。方法2009年3月至2012年12月间86例老年食管癌患者,随机均分为同步放化疗组和单纯放疗组,2组均采用三维适形调强放射治疗,放疗剂量60~66 Gy。同步化疗方案为NDP 80 mg/m^2,第1天,替加氟800~1000 mg/d,第1~5天,放疗开始时同步静脉输注,每隔28 d重复1次,放疗期间同步化疗2周期。结果同步放化疗组完全缓解(CR)22例,部分缓解(PR)18例,无缓解(NR)3例,总有效率为93.0%;单纯放疗组CR 18例,PR 14例,NR11例,总有效率为74.4%,2组总有效率比较差异有统计学意义(χ~2=4.181,P=0.041)。同步放化疗组的1、2年的生存率分别为86.0%、65.1%,均高于单纯放疗组的67.4%、41.9%(P<0.05)。同步放化疗组Ⅲ~Ⅳ级白细胞下降、恶心、呕吐反应高于单纯放疗组(P<0.05),但经过升白细胞药物、止吐药物处理后患者均能较好耐受。结论 NDP与替加氟同步化疗联合放疗治疗老年食管癌疗效佳,治疗不良反应可以耐受,远期疗效尚待进一步观察。

Objective To analyze the clinical effect of nedaplatin plus tegafur combined with radiotherapy on esophageal carcinoma in th ekderly patients. Methods 86 patients were randomly divided into radiotherapy group and concurrent chemotherapy group. Patients in both groups received intensity modulated radiation therapy with a total dose of60-66 Gy. Concurrent chemotherapy group received nedaplatin plus tegafur（ nedaplatin 80 mg / m^2,the first day and tegafur800-1000 mg / d,1st-5th day,by intravenous infusion） additionally,lasted for 2 cycles. Results 22 patients got complete remission and 18 got partial remission in concurrent chemotherapy group,and the effective rate was 93. 0%. 18 patients achieved complete remission and 14 patients achieved partial remission in radiotherapy group,and the effective rate was 74. 4%（ χ^2= 4. 181,P = 0. 041）. The 1-year survival rate of two groups was 86. 0% and 67. 4% respectively; two-year survival rate were 65. 1% and 41. 9%,respectively（ P 〈0. 05）. The incidenie rates of grade 3-4 leucopenia,nausea and vomiting in concurrent chemotherapy group were higher than those in radiotherapy group（ P 〈0. 05）. Conclusions Nedaplatin plus tegafur combined with radiotherapy can effectively treat esophageal cancer in elderly patients. The side toxicity is acceptable. But the long-term follow-up result need further observation.