替吉奥联合3D-CRT与微波热疗治疗老年局部晚期食管癌的临床观察

Clinical Observation of Tegafur Gimeracil Oteracil Potassium Combined with 3D-CRT and Microwave Hyperthermia in the Treatment of Elderly Patients with Local Advance Esophageal Cancer

目的:观察替吉奥联合三维适行放射治疗(3D-CRT)与微波热疗治疗老年局部晚期食管癌的临床疗效及安全性。方法:将48例局部晚期老年食管癌患者按随机数字表法分为A、B、C组,各16例。A组患者给予局部3D-CRT,总剂量60~66 Gy,共治疗6~7周;B组患者在A组基础上口服替吉奥60 mg/(m^2·d),bid,3周为1个疗程,直到放疗结束;C组患者在B组基础上行微波热疗,3周为1个疗程,直到放疗结束。比较3组患者放疗结束后,临床疗效、1年生存率及吞咽困难、体质量、卡氏(KPS)评分变化情况,并观察3组患者主要毒副反应(放射性食管炎、放射性肺炎、胃肠道反应、骨髓抑制)发生情况。结果:C组患者总有效率为93.75%,1年生存率为87.50%,吞咽困难缓解率为93.75%。明显高于A组的50.00%、50.00%、56.25%和B组的68.75%、68.75%、68.75%,差异均有统计学意义(P<0.05)。3组患者体质量增加率及KPS评分增加率比较,差异均无统计学意义(P>0.05)。C组患者放射性食管炎、肺炎发生率均显著低于A组和B组,差异均有统计学意义(P<0.05);3组患者胃肠道反应、骨髓抑制发生率比较,差异均无统计学意义(P>0.05)。结论:替吉奥联合3D-CRT与微波热疗能显著提高老年局部晚期食管癌的临床疗效和生存率,且毒副反应相对较低。

OBJECTIVE：To observe clinical efficacy and safety of tegafur gimeracil oteracil potassium combined with 3DCRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer. METHODS：48 cases of local advance esophageal cancer were divided into group A,B and C according to random number table method,with 16 cases in each group according to random number table method. Group A was given 3D-CRT with total dose of 60-66 Gy totnlly for 6-7weeks;group B was additionally given tegafur gimeracil oteracil potassium 60 mg/（m^2·d）,bid,on the basis of group A 3 weeks for a course of treatment,until the end of radvotherapy;group C was additionally given thermotherapy on the basis of group B 3weeks for a course of treatment,until the end of radvotherapy. Clinical efficacy,1-year survival rate,dysphagia,weight and KPS score were compared among 3 groups,and the occurrence of toxic reactions（radioactive esophagitis,radioactive pneumonia,bone marrow suppression and gastrointestinal reaction）were observed in 3 groups. RESULTS：Total effective rate,1-year survival rate and the remission rate of dysphagia of group C were 93.75%,87.50% and 93.75%,which were significantly higher than those of group A（50.00%,50.00% and 56.25%）and B（68.75%,68.75% and 68.75%）,with statistical significance（P〈0.05）. There was no statistical significance in the rate of weight gain and KPS score gain among 3 groups（P〈0.05）. The incidence of radioactive esophagitis and radioactive pneumonia in group C were significantly lower than in group A and B,with statistical significance（P〈0.05）;there was no statistical significance in the incidence of gastrointestinal reaction and bone marrow suppression among 3 groups（P〉0.05）. CONCLUSIONS：Tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer further improves clinical efficacy and survival rate,but shows low incidence of toxic reaction.