晚期不可手术食管鳞癌化疗方案的选择

The scheme selection of chemotherapy regimens for the advanced unresectable esophageal squamous cell cancer

目的:本研究旨在评价一线不同化疗方案联合放疗对晚期不可手术食管鳞癌患者的近期疗效与安全性。方法:回顾性分析2009年8月-2014年2月在浙江医院就诊的81例晚期不可手术的食管鳞癌患者,一线给予不同化疗方案联合放疗进行治疗直至疾病进展。卡方检验比较不同化疗方案在缓解率及疾病控制率方面有无差异,Kaplan-Meier法进行生存分析和比较。结果:39例5-氟尿嘧啶联合顺铂(PF,氟尿嘧啶1 000 mg/m^2d 1-5、顺铂75 mg/m^2d 1-3)方案、21例紫杉醇联合顺铂(PC,紫杉醇150 mg/m^2d 1、顺铂75 mg/m^2d 1-3)、21例多西他赛、顺铂联合5-氟尿嘧啶(DCF,多西他赛60 mg/m^2d 1、顺铂70 mg/m^2d1-3、氟尿嘧啶500 mg/m^2d1-5)与接受放疗的患者客观缓解率(objective response rate,ORR)分别为25.6%、23.8%、38.1%,疾病控制率(disease control rate,DCR)分别为64.3%、61.9%、66.7%,中位无进展生存期(median progression-free survival,m PFS)分别为7.34、7.10、9.20个月,中位总生存期(median overall survival,m OS)分别为18.03、16.10、18.83个月。常见的毒副反应为骨髓抑制,PF、PC、DCF方案的骨髓抑制发生率分别为17.9%、14.2%、19.04%。结论:三种方案均可作为一线治疗食管癌化疗方案,且耐受性好。

AIM： To evaluate efficacy and safety of different chemotherapy regimens combined with radiotherapy for advanced unresectable esophageal squamous cell cancer. METHODS： 81 patients with advanced esophageal squamous cell cancer were given different chemotherapy combined with radiotherapy until disease progression was retrospectively analyzed from August 2009 to February 2014. The chi-square test was used to compare whether there is difference in disease control rate of different chemotherapy,Kaplan-Meier was used to analysis survival and comparison. RESULTS： 39 cases of 5-FU in combination with cisplatin（ PF,fluorouracil 1 000 mg/m^2 d 1- 5 and cisplatim 75 mg/m^2d1- 3）,21 cases of paclitaxel and ciplatin（ PC,paclitaxel 150 mg/m^2 d 1 and cisplatin 75 mg/m^2 d1- 3）,21 cases of docetaxel,cisplatin combined with 5-fluorouracil（ DCF,docetaxel 60 mg/m^2d1,cisplatin 70 mg/m^2 d1 and fluorouracil 500 mg/m^2 d1-5） in patients receiving radiotherapy and objective response rate was respectively 25. 6%, 23. 8%,38. 1%, disease control rate was respectively64. 3%,61. 9%,66. 7%,the median progressionfree survival were 7. 34,7. 10,9. 20 months,and median overall survival were 18. 03,16. 10,18. 83 months. The common toxicities of drug is myelosuppression,the occurrence of bone marrow suppression of PF,PC,DCF was 17. 9%,14. 2%,19. 04%.CONCLUSION： The three chemotherapy regimens can be effective in the treatment of esophageal cancer,and well tolerated.