单周多西他赛联合顺铂同步放化疗治疗晚期食管癌的临床效果

Clinical efficacy of concurrent radiochemotherapy using docetaxel combined with cisplatin every week for treatment of advanced esophageal cancer

目的评价单周多西他赛联合顺铂同步放疗治疗晚期食管癌的疗效与安全性。方法选择晚期食管癌患者35例,在第1、3、5、7、9周的第1天给予多西他赛20 mg/m2及顺铂25 mg/m2化疗,同时行调强放射治疗,2 Gy/d,每周5次,共10周。观察患者的疗效、生存情况、吞咽困难情况及毒副反应。结果共33例患者完成同步放化疗,其中完全缓解8例(24.2%),部分缓解20例(60.6%),病情稳定4例(12.1%),病情进展1例(3.0%)。治疗前患者出现吞咽困难34例,治疗后吞咽困难完全缓解17例(50.0%),有所改善12例(35.3%),无改善4例(11.8%),恶化1例(2.9%)。治疗后吞咽困难评分为(2.19±0.37)分,低于治疗前的(3.22±0.41)分(P<0.05)。吞咽困难改善中位时间为29 d,吞咽困难改善的中位持续时间为8.4个月。治疗期间最常见的毒性反应是食管炎,并发气管-食管瘘2例。随访期内死亡23例,中位总体生存时间为26.9个月,中位无进展生存时间为13.5个月;2年、3年无进展生存率分别为38.9%和16.7%;2年、3年总体生存率分别为52.8%和27.8%。结论单周多西他赛联合顺铂同步放化疗方案治疗晚期食管癌安全、有效,且患者耐受性好。

Objective To evaluate the safety and efficacy of concurrent radiochemotherapy using docetaxel combined with cisplatin every week for the treatment of advanced esophageal cancer. Methods Thirty-five patients with advanced esophageal cancer received chemotherapy of docetaxel（20 mg/m2） and cisplatin（25 mg/m2） on the first day of the first,third,fifth,seventh,ninth week,and received intensity modulated radiation therapy（2 Gy/d,five times a week） for 10 weeks. The efficacy ,survival rate ,incidence of dysphagia and toxic reactions were observed in all patients. Results Of 33 patients,8（24. 2% ） ,20（60. 6% ） ,4（ 12. 1% ） and 1 （3.0%） acquired complete remission,partial remission,stable disease and disease progression respectively after concurrent radiochemotherapy. Of 34 patients with dysphagia before treatment, complete remission was observed in 17 cases （50.0%） , improvement in 12 cases （35.3%） , no improvement in 4 cases （11.8% ） and progression in 1 case（2.9% ） after treatment. The score for dysphagia after treatment was （2.19 ~ 0.37 ）, and was lower than that before treatment （ 3.22 ± 0.41, P 〈 0.05 ）. The median time of dysphagia improvement was 29 days, and the median duration of dysphagia improvement was 8.4 months. During the treatment,the most common toxic reaction was esophagitis, and tracheoesophageal fistula occurred in 2 cases. Twenty-three patients died during the follow-up. The median overall survival and progression-free survival were 26.9 months and 13.5 months respectively. The 2- and 3-year progression-free survival rates were 38.9% and 16.7% respectively. The 2- and 3-year overall survival rates were 52.8% and 27.8% respectively. Condusion Concurrent radiochemotherapy using docetaxel combined with cisplatin every week is safe, effective and well-tolerated for the patients with advanced esophageal cancer.